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special Attention is called to the following : 

The next Annual Meeting of the Medical Society 


OF New Jersey will be held at Asbury Park, on the 
28th, 29th and 3bth of June, 1898. 

Each District Society is entitled to three Delegates 
at large and one additional for every ten members. 
Permanent delegates will be elected at this session. 

The District Reporters are requested to send their 
reports to the Chairman of the Standing Committee 
at least three weeks before the time of the Annual 

The Standing Committee would remind Reporters 
that their reports are to be published in the volume of 
Transactions, and should therefore be carefully pre- 
pared, and that names and medical terms especially 
should be distinctly written. Reports from other 
physicians should be incorporated in their own report. 

The assessment for the year 1897, upon District 
Societies, is two dollars for each member. 

The Secretaries of the respective Societies are 
requested to send a list of Delegates and Members, 
with postoffice addresses, to the Recording Secre- 
tary, Dr. Wm. Pierson, Orange, at least ten days 
before the Annual Meeting. 


This prize is open for competition to the members of 
the District Medical Societies. 

The Essays must be signed with an assumed name and 
have a motto, both of which shall be endorsed on a sealed 
envelope, to accompany the Essay, containing the author's 
name, residence and District Society. 

The Essays must be placed in the hands of the chair- 
man of the Committee, on or before the Fourth Tuesday 
in May, 1898. 

The Committee will select the first two essays in order 
of merit. To the first will be awarded the prize of one 
hundred dollars ; to the second, that of honorary mention. 

The unsuccessful authors will receive back their essays 
upon their identification to the chairman of the Commit- 
tee. The successful Essays will be the property of the 
Society and be published in its Transactions. 

T. J. SMITH, Chairman, Bridgeton, 

C. J. KIPP, Newark, 

P. A. HARRIS, Paterson. 




Medical Society 




L. J. Hardhatn, Printer, 243 6* 245 Market Street, Newark, N» J. 


OFFICERS, 1897. 



DAVID C. ENGLISH, - - - New Brunswick 


C. R. p. FISHER, - - - - Bound Brook 

LUTHER M. HALSEY, - - - Williamstown 


E. L. B. GODFREY, Camden 








STEPHEN PIERSON, - - - Morristown 


HENRY W. ELMER, .... Bridgeton 

HENRY MITCHELL, - - - Asbury Park 


M. LAMPSON, Jersey City 



• ♦• 

All persons who shall have been, oi may hereafter be President of the Society, shall rank a& 
Fellows, and be entitled to all the privileges of delegated members. 

Act of Incorporation, Sec. x. 
The dates represent the year of official service as President. 
Those marked thus (*) are deceased. 

♦Robert McKean 1766 *Charles Smith 

♦William Burnett 1767 ♦Matt. H. Williamson. 

♦John Cochran 1768 

♦Nathaniel Scudder 1770 

♦Isaac Smith 1771 

♦James Newell 1772 

♦Absalom BAINBRIDGE....1773 

♦Thomas Wiggins 1774 ♦Lewis Condict 

♦Hezekiah Stites 1775 *James Lee 

♦Samuel Forman. 
♦John Van Cleve. 
♦Lewis Dunham*... 
♦Peter I. Stryker, 
♦John Van Cleve. 

     ♦William G. Reynolds.. 

♦John Beatty 1782 ♦Augustus R. Taylor... 

♦Thomas Barber 1783 ♦William B. Ewing 

♦Lawrence Van Derveer. 1 784 ♦Peter L Stryker 

♦Moses Bloomfield 1785 ♦Gilbert S. Woodhull.. 

♦William Burnett 1 786  Wm. D. McKiss ack .... 

♦Jonathan Elmer 1787 ♦Isaac Pierson 

♦James Stratton 1788 ♦Jeptha B. Munn 

♦Moses Scott. 1789 ♦John W. Craig 

♦John Griffith 1790 ♦Augustus R. Taylor. . . 

♦Lewis Dunham 1791 ♦Thomas Yarrow 

♦Isaac Harris 1792 ♦Fitz Randolph Smith.. 

♦Elisha Newell 1795 ♦William Forman 

♦Jonathan F. Morris 1807 ♦Samuel Hayes 

♦Peter I. Stryker 1808 ♦Abm. P. Hageman 

♦Lewis Morgan 1809 ♦Henry Van Derveer. . . 

♦Lewis Condict 1810 ♦Lyndon A. Smith 





















*Benj. H. Stratton 

♦Jabez G. Goble 

♦Thomas P. Stewart 

♦Ferdinand S. Schenck.. 

♦Zachariah Read 

♦Abraham Skillman 

♦George R. Chetwood. . . 

♦Robert S. Smith 

♦Charles Hannah 

♦Jacob T. B. Skillman 

Samuel H. Pennington. 

♦Joseph Fithi an 

♦Elias J. Marsh 

♦John H Phillips 

♦Othn'l H. Taylor 

♦Samuel Lilly. 

♦A. B. Dayton 

♦J. B. Coleman 

♦Richard M. Cooper 

♦Thomas Ryerson 

♦Isaac P. Coleman 

♦John R . Sickler 

♦Wm. Elmer. 

♦JNO. Blane 


♦Theo. R. Varick 

♦Ezra M. Hunt 

♦Abram Coles 

♦Benjamin R. Bateman.. . 
jNO. C. Johnson 

838 *Thomas J. Corson 1868 

839 ♦William PiERSON 1869 

840 ♦Thomas F. Cullen 1870 

841 ♦Charles Hasbrouck 1871 

842 Franklin Gauntt 1872 

843 *T. J. Thomason 1873 

844 ♦G. H. Larison 1874 

845 ♦Wm. O'Gorman 1875 

846 ♦jNO. V. SCHENCK 1876 

847 Henry R. Baldwin.. .. . . 1877 

848 John S. Cook 1878 

849 Alex. W. Rogers 1879 

850 ♦Alex. N. Dougherty 1880 

851 ♦Lewis W. Oakley 1881 

852 ♦John W. Snowden 1882 

853 ♦Stephen Wickes 1883 

854 P. C. Barker 1884 

855 ♦Joseph Parrish 1885 

856 Charles J. Kipp 1886 

857 John W.Ward 1887 

858 H. Genet Taylor 1888 

859 ♦B.A.Watson 1889 

860 ♦Jas. S. Green 1890 

861 Elias J. Marsh 1891 

862 George T. Welch 1892 

863 John G. Ryerson 1893 

864 O. H. Sproul 1894 

865 William Elmer 1895 

866 T.J.Smith.. 1896 



•  • 

''David Hosack, New York 

*J. W. Francis 

♦John Condict. Orange 

♦Usher Parsons. Rhode Island 

♦Reuben D. Murphy. Cincinnati 

 Alban G. Smith. New York 

♦Willard Parker. New York 

♦Valentine Mott, New York 

♦Jonathan Knight. New Haven 

♦Nathaniel Chapman. Philadelphia 

♦Alexander H. Stephens, New York.. 

♦JOHN C. Warren. Boston 

♦Lewis C. Beck, New York 

♦John C. Torrey. New York 

♦George B. Wood, Philadelphia 

H. a. Buttolph. Short Hills, N. J 

ASHBEL Woodward. Franklin, Conn 

♦Thomas W. Blatchford. Troy. N. Y. . 
♦Jeremiah S. English. Manalapan. N. J. 

♦Stephen Wickes. Orange. N. J 

♦S. O. Vanderpool, Albany. N. Y 

♦Joseph Parrish, Burlington. N. J 

♦Ferris Jacobs, Delhi. N. Y 

C. A. LiNDSLEY. New Haven. Conn 

Wm. Pepper. PhiUdelphia 

S. WiER Mitchell, Philadelphia. 

Cyrus F. Brackett. Princeton, N. J 

♦Joseph C. Hutchinson. Brooklyn, N. Y 

Thomas Addis Emmett, New York. . . . 

♦Isaac E. Taylor, New York 

*D. Hayes Agnew, Philadelphia 

♦Jos. Leidy, Philadelphia 

Frederick S, Dennis. New York 

♦John H. Ripley. New York 

Virgil P. Gibney, New York 

William Pierson, Orange, N. J 

Abram Jacobi, New York 

Virgil M. D. Marcy, Cape May City... 















Henry C. Neer, 
James M. Ridge, - 

♦Alex. Marcy, - 
W. H. C. Smith, - 
Charles Young, 
John H. J. Love, - 
Arthur Ward, 

♦Joseph C. Young, 
Isaac S. Cramer, 


♦J. Howard Pugh, 
♦Robert F. Chabert, 
Cornelius Shepard, 
♦C. H. Andrus, 
Henry Mitchell, - 
Henry C. Cooke, 
i. w. condit, - 
John Stigkr, 
W. B. Johnson, 
H. G. Wagnor, - 
♦Sidney Strailey, - 
♦John H. Griffith, 
♦Alonzo Pettit, 
♦E. B Silvers, 
P. A. Harris, - 

1892 George Evans Reading, 1893 

- 1892 B. A. Waddington, - 1893 
1892 ♦John Helm, - - - 1895 

- 1892 W. H. Vreeland, - 1895 
1892 O. B. Gross, - - - 189s 

- 1892 D. W. Blake. - - 1895 
1892 , N. Newlin Stokes. - 1895 

- 1892 Levi Farrow, - - 1895 
1892 George C. Laws, - - 1895 

- 1892 ♦E. Morrison, - - 1895 
1892 ♦H. M. Weeks, - - 1895 

- 1892 R. R. Rogers, Sr.. - 1895 
1892 William H. Ireland, - 1895 

- 1892 ♦George R. Kent. - 1896 
1892 William J. Chandler, - 1896 

- 1892 Edward J. Ill, - - 1896 
1892 George H. Balleray, - 1896 

- 1892 ♦J. A. Coles, - - 1896 
1892 William S. Creveling, 1896 

- 1892 George Bayles, - 1896 

1892 tDANiEL M. Skinner, - 1896 

- 1892 ♦Herman C. Bleyle, - 1896 

1893 ♦T. H. Tomlinson. - - 1896 

- 1893 William H. McGee, - 1896 
1893 S. O. B. Taylor, - - 1897 

* Not present, 
t Resigned. 

Members of District Medical Societies 




(District Society organized June 7, i8do.) 


W. B.Sttvf dirt, Pres.,A^/afttic City B.C.Pennington, Atlantic City 

Emery Marvel, 
W. M. Pollard, 

F. W. Bennett, 
E. C. Chew, 
E. A. Keiley, 

G. P. Gelring, Bakersville 
J. M. Elmer, Egg Harbor City 
E. H. Madden, Absecon 
H. C. James, May 5 Landing 
Edward North, Hammonton 
T. Boysen, Egg Harbor City 

A. D. Cuskaden, V.-Pres,, " 

W. Reynolds, 5>^V 6- Treas.,** 

W. E. Darnall, Rep,, 

Philip Marvel, 

E. L. Reed, 

Tabot Reed, 

L. R. Souder, 

J. A. Joy, 

J. B. Thompson, 

Boardman Reed, 

W. M. Powell, 

No. Members, 24. 










(District Sodety reorganized February a8, 1854.) 

L. B. Parselk, Pres,, Closter Sam'l E. Armstrong, 

G. H. McFadden, V.-Pres,, J. T. De Mund. 

Hackensack William L. Vroom, 

D. St. John, Treas,, '* H. C. Neer, 

D. A. Currie, Sec'y, Englewood Eugene Jehl, 

H. C. Elsing, Ridgefield Park Samuel J. Zabriskie, 

M. S. Ay res, Fairview . J. W. Terry, 

H. M. Banks, Englewood J. A. Wells, 

A. L. Vandewater, Hackensack J. W. Proctor, • 

Edgar K. Conrad, ** Joseph Hftgcr, 



Park Ridge 





Fort Lee 



Charles D. Brooks, Hackensack J. Talmage Wyckoff, Leonia 

J. B. W. Lansing, Tenafly Charles Calhoun, Rutherford 

John J. Haring, ** J. E. Pratt, SckraaUnburgh 

No. Members, 25. 


(Society organized May 19, 1829. Meets third Tuesday in Jan., April, June and Oct) 

J. H. Pugh, Pres, and Censor, 

B. W. Macfarland, V.-Pres., 

A. W. Taylor, Sec*y, Beverly 

E. Hollingshead, 7r., Pemberton 

F. S. Janney, Historian, Riverton 
Joseph Stokes, Rep., Moorestown 

Irene D. Young, 
Franklin Gauntt, 
W. C. Parry, 
R. H. Parsons, 
A. H. Small, 
T. S. Lippincott, 
Emma P. Weeks, 
Lewis L. Sharp, 



Mount Holly 



W. E. Hall, Censor, Burlington J. Reeve, 


Alex. Marcy, 
W. P. Melcher, 
F. A. Gauntt, 
N. N. Stokes, 
F. G. Stoud, 
A. E. Conrow, 
W. H. Shipps, 

Riverton J. D. Janney, 
Mount Holly Wm. L. Martin, 

T. T. Price, 
David Baird, Jr., 
J. E. Dubell, 
I. W. Hollingshead, 











William Martin, Bristol, Pa, 


E. P. Townsend, Billings, Mont, Chas. H. Thomas, 
Chas. P. Noble, 1633 Locust St., Phila., Pa. 

1637 N. Broad St., Phila., Pa. 

No. Members, 29. 


(Organized Aug. 14, 1846. Meets second Tuesday in May, Oct., Dec. and Feb.) 

D. M. Stout, Pres., 

Berlin H. H. Sherk, Historian, Stockton 

Daniel Strock, V.-Pres., Camden H. G. Taylor, Censor &^ Trustee, 

B. S. Lewis, Sec'y, 
J. G. Doron, Treas., 
O. W. Braymer, Rep., 



H. E. Branin, Censor, Blackwood 
Alex. Marcy, " Riverton 







H. A. M. Smith, Censor, Gloucester 

W. H. Ireland, *' Camden 

Alexander Mecray, Trustee, 

Edmund L. B. Godfrey, ** 

Joseph S. Baer, 

Wilson G. Bailey, 

Philip W. Beale. 

Dowling Benjamin, 

John K. Bennett, 

Duncan W. Blake, 

Howard G. Bonvvill. 

Sylvan G. Bushey, 

Robert Casperson, 

William A. Davis, 

Eugene E. De Grofft, 

Clarence B. Donges, 

John W. Donges, 

Henry C. Fisler, Merchantville 

Joel W. Fithian, Camden 

Onan B. Gross, " 

J. J. Haley, 

Levi B. Hirst, 

Conrad G. Hoell, 

Frank L. Homing, 

Jos. E. Hurif, 

William H. Iszard, 

Henry Jarrett, " 

Chas. H. Jennings. Merchantville 

Wm. B. Jennings, Haddonfield 

Wm. S. Jones, Camden 

Wm. W. Kain, 













Wm. H. Kensinger, Stockton 

Grant E. Kirk, Camden 

John F. Leavitt, ** 

Adrinette Le Fevre, 

A. H. Lippincott, 

Frederick W. Marcy, " 

John W. Marcy, Merchantville 

Paul Mecray, Camden 

Wm. E. Miller, 

Marcus K. Mines, •* 

Alexander McAlister, " 

Joseph L. Nicholson, 

Milton M. Osmun, 

Howard F. Palm, 

Wm. R. Powell. 

William H. Pratt, 

Sophia Presley, 

James M. Ridge, 

Frank N. Robinson, 

Edward A. Y. Schellinger, 

William Shafer. 

Chas. H. Shivers, 

James G. Stanton, 

John R. Stevenson, 

John F. Stock, 

Wm. A. Westcott, 

Maximilian West, 

Joseph H. Wills, 

William P. Wingender, 

E. B. Woolston, Marlton 











George W. Boughman, Delaware D. P. Pancoast, 
C. G. Garrison, Merchantville J. Orlando White, 
J. W. Hewlings, Moorestown J. Gilbert Young, 

Richard. C . Dean , U, S, N,, 

No. Members, 70. 

Mullica Hill 





(Society organized March i3, 1885. Meets first Tuesday in April and Nov.) 

W. A. Lake, Pres,, Green Creek 

A. L. Leach, V.-Pres.^ Cape May 
J. Way, Secy &^ Rep., Court House 
R. Marshall, Treas., Tuckahoe 
V. M. D. Marcy, Censor, Cape May 
Walter S. Learning, " 

B. T. Abbott, *• Ocean City 
Eugene Way, Dennisville 
James Mecray, Cape May 
Emlen Physic, *' 

No. Members, 19. 

I. M. Downs. 
Joseph Marshall, 
Jonathan Learning, 
Coleman Leaming, 
John S. Douglass, 
Charles B. Corson, 
N. A. Cohen, 
Charlee M. Gandy, 
J. H. Ingram, 

Court House 


Court House 



So, Seaville 


U. S. Army 



(Society organized Dec. 8, 181 8.) 

H. W. Elmer, Pres., Bridget on 

A, R. Judson, V.-Pres., Newport 

Hamilton Mailly, Sec*y, Bridgeton 

Jos. Tomlinson, Treas,, •* 

J. C. Applegate, Rep., 

D. H. Oliver, 

M. K. Elmer, 

J. R. C. Thompson, 

T. J. Smith. 

Joseph Shepperd, 

Ellsmore Stites 

Alfred Cornwell, 

S. M. Wilson, 

T. G. Davis, 

J. B. Ware, 

Chas. W. Wilson, Vineland 

O. H. Adams, 







• < 




W. F. Sawyer, 
Ed. H. Bidwell, 
John S. Halsey, 
W^ L. Newell, 
W. H. C. Smith. 
C. J. Massinger, 
J. W. Wade, 
G. E. Day, 
Ephriam Bateman, 
Frank Bateman, 
S. M. Snyder, 
E. B. Sharp» 
A. W. Sullivan, 
J. R. Dare. 
N. H. Burt, 
L. L. Hand, 
S. T. Day. 


loAa S. Whithaker, MilMtU, 

















Port Norris 

No. Members, 34. 


(Society org^antxed June 8, 1816. Annual meeting first Tuesday in ApriL) 


T. Y. Sutphen, Pres,, Newark 
C. F. Underwood, y,-Pres., " 
Archibald Mercer, Secy^ 
Charles D. Bennett, Treas., 
Theo. W. Corwin, Rep.^ 



William B. Arnold, 
Maurice Asher, 
Charles H. Bailey, 
Aaron K. Baldwin, 
Samuel H. Baldwin, 
George Bayles, 
Fred. W. Becker, 
Herman C. Bleyle, 
John H. Bradshaw, 
Rudolph Braun, 

Walter Dodge, Orange 

Arthur C. Dougherty, Newark 

John L. Duryee, 

Wells P. Eagleton, 

David J. Edwards, 

Orange Thomas P. Edwards, 

Newark Julius Egge, 

Bloomfield David E. English. 

Newark Jaines R. English, 

" Thomas Dunn English, Newark 

Orange Joseph, Fewsmith. " 

Newark Thomas S. Fitch, Orange 

" Paul Fitzgerald. Newark 

Orange Richard P. Francis, Montclatr 

Newark Richard D. Freeman, So, Orange 


William M. Brien, Orange Valley Albert Frey, 


James S. Brown, 
Walter R. Bruyere, 
William Buermann, 
Edwin L. Burns, 
Robert L. Burrage, 
Carl Btlttner, 
William E. Carroll, 
Levi W. Case, 





Ruel S. Gage, 
William Gauch, 
Robert F. Gillin, 
Herman A. Glatzmayer, 
William Glatzmayer, 
Orange William M. Goodwin, 
Newark William B. Graves, 
Montclatr Thomas N. Gray, 
William J. Chandler, So, Orange Charles W. Hagen, 
Robert W. Chapman, Newark Joseph F. Hager. 

Irvington Frederick W. Hagncy, 
Newark Eleanor Haines, 
Levi W. Halsey. 





E, Orange 



Albion C. Christian, 
J. Henry Clark, 
Henry L. Coit. 
Event P. Cortright, 
H. Bedell Crane, 






Edward H. Hamill, 
Mary Harlcy, 
E. Zeh Hawkes, 
Joseph H. Haydon, 


Mathias S. Crane, 

William H. K. Davis, E, Orange 

John Dennis, Newark John Hemsath, 

Rich'd G. P. Dieffenbach, " Hugh C. Hendry, 

Daniel M. Dill. " Henry I. Herold, 

Waiiam S. Disbrow. '* Herman C. H. Herold, 

















Livingston S. Hinckley, Newark 

James S. Hoffman, 

Edgar Holden, 

L. Eugene Hollister, 

William H. Holmes, Orange 

Thomas N. Harvey, ** 

John C. Houston, Newark 

Charles J. Ill, 

Edward J. Ill, 

Frederick C. Jacobson, 

Jotham C. Johnson, 

William M. Johnson, 

George R. Kent, 

Charles J. Kipp, 

Jos. M. W. Kitchen, E, Orange 

Francis E. Knowles, So. Orange 

Henry A. Kornemann, Newark 

Charles Lehlbach, 

Jesse D. Lippincott. 

F. W. Lockwood, East Orange 

Herbert W. Long, Newark 

John H. J. Love, Montclair 

Thomas W, Loweree, Newark 

Calista V. Luther, 

Ernest M; Lyon, 

Floy McEwen, 

William H. McKenzie, 

William H. Martland, 

Henry E. Mathews, Orange 

Sarah R. Mead, Newark 

Pancrazio M. Megaro, *' 

W. D. Mitchell, East Orange 

Franklin M. Meyer, Newark 

Andrew M. Mills, 

Clement Morris, 

Frederick C. Nadler, 

Albert B. Nash, • 

Emanuel Newman, 

Richard C. Newton, -'Montclair 


So, Orange 
















Joseph D. Osborne. Newark 

Edward E. Peck, Caldwell 

Samuel H. Pennington, Newark 

William Pennington, Irving ton 

Thomas F. Phelan, Orange 

William Pierson, *' 

Robert C. Potter, 

Henry A. Pulsford, 

John M. Rand, 

Charles D. Randall, 

William Rankin, Jr., 

Joshua W. Read, 

Phillip Ricord, 

Charles D. Ripley, 

Samuel E. Robertson, 

Benjamin A. Robinson, '* 

Manning N. Robinson, '* 

William D. Robinson, E, Orange 

Hugh P. Roden, Newark 

William J. Roeber, 

Robert H. Rogers, 

George W. Rolerfort, 

Meflford Runyon, So, Orange 

Charles A. Schureman, Newark 

Emanuel Schwartz, 

Edward Sealy, 

William F. Seidler, 

Marco Seidman, 

William F. Shiek, 

M. Herbert Simmons, 

Daniel M. Skinner, 

Anna L. Smith, 

E. Fayette Smith, 

D. Winans Smith, 

Joseph F. Somerhof, 

Lott Southard, 

Edward Staehlin, 

Robert G. Stanwood, 

Joseph W. Stickler, Orange 















Joseph F. Sutphen, 

Robert M. Sutphen, 

James S. Taylor, 

J. Francis Tetreault, 

Frederick W. Thum, 

Henry A. Towle, 

Sidney A. T winch, 

M. H. Cash Vail, 

Geo. A. Van Wagenen, Newark 

George N. Wait, 

David L, Wallace, 

Henry J. F. Wallhauser, 

Aaron C. Ward, 

Arthur Ward, 

Edwin M. Ward, 

Leslie D. Ward, 




Newark William S. Ward, Newark 

William H. Warren, 
Orange Walter S. Washington, 
" Frederick Webner, 

William H. White, Bloomfield 
Henry B. Whitehorne, Verona 
Albert Wickham, Newark 

W. Stockton Wilson, 
Charles H. Winans, 
Edward E. Worl, 
James A. Wormley, 
James T. Wrightson, 
Charles Young, 
*' Joseph C. Young, 

Bloomfield Charles M. Zeh, 




No. Members, 183. 


(Society organized December, 1818.) 

J. Gaunt Edwards, Pres., 

George E. Reading, Sec'y and 

Treas., Woodbury 
Charles S. Heritage, Rep., 

James Hunter, Censor, Westville 
Luther M. Halsey, Censor, 

Harry A. Stout, Censor, Wenonah 
Howard A. Wilson, Woodbury 
William Brewer, 
Henry B. Diverty, 

No. Members, 22. 


(Society organized October i, 1851.) 

J. M. Rector, Pres., Jersey City J A. Exton, Rep,, 

Henry Spence, Secy., *' O. R. Blanchard. 

H. H. Brinkerhoff, Jr., Treas,, W. S. Boyd, 

Jersey City J J. Broderick, 



Thomas Lee, Woodbury 

Henry C. Clark, " 

Henry H. Clark, 

George W. Bailey, 

Eugene Z. Hillegass, 

M. Jones Luffbary, 

H. G. Buckingham, 

Samuel F. Stranger, Harrisonville 

Cyrus B. Phillips, Hurffville 

George C. Laws, Paulsboro 

Eugene T. Oliphant, Bridgeport 

P. E. Stil wagon, 

Samuel F. Ashcraft, Mullica Hill 





Jersey City 



J. C. Parsons, 
E. L. Bull, 
C. F. Kyte, 
Ulamer Allen, 
C. W. Cropper, 

B. P. Craig, 

J. E. Corrigan. 
T. R. Chambers, 
G. K. Dickinson, 

E. K. Dunkle, 
Benj. Edge, 
John Faber. 

J. R. Everitt, 
Jos. F. Finn, 
W. F. Faison, 
L. J. Gordon, 

F. D. Gray, 
J. P. Henry. 
C D. Hill, 
P. Hoffman, 
A. J. Kirsten, 
Mortimer Lampson, 
H. H. Lynch, 

C. R. Law, 

G. E. McLaughlin. 
J. J. McLean, 

No. Members, 59. 

Jersey City 




















Jersey City 


Bergen Point 

H. M. Smith, 
I. N. Quimby, 
J. D. McGill, 
W. P. Watson, 
Conrad Wienges, 

E. G. Marks, 
H. H. Burnett, 
R. F. Chalbert, 
C. A. Gilchrist, 
S. A. Heifer, 
J. H. Rosenkranz, 

F. M. Corwin, 
L. F. Donohue, 
A. Dallas. 
Walter Pocock, 

G. H. Sexsmith, 
W. J. Parker, 
H. B. Rue. 
J. E. West, 

E. P. Buffett 

F. E. Noble, 
C. H. Purdy, 
F. Boyer, 
T. H. Atkinson, Bergen Point 
J. C. Kilgore. 
J. G. L. Borgmeyer, 




Jersey City 







(Society organized June 12, 1821.) 

Fred. L. Johnson. Pres.^ Stantcn W. S. Creveling, 

0. H. Sproul, Sec*y^ Flemington John H. Ewing, 

1. S. Cramer, Treas,, " John H. Fritz, 
Geo. N. Best, Rep,, Rosemont Frank E. Grim, 
N. B. Boileau, Jutland M. D. Knight, 
W. E. Berkaw, Annandale E. D. Leidy, 
A. W. Cooper, Mt, Pleasant, Pa, F. W. Larison, 
E. W. Closson, Ldmbertville E. H. Moore, 
W. E. Cornog, Seargeantsville 








White House 




M. Abel, Providence, R, /. W. D. Wolverton, U. S. Army 

No. Members, 17. 


(Society organized May 33, 1848.) 

C. R. Burroughs, Pres., 


T. H. McKenzie, 


J. Bruyere, V.Pres., 


C. H. Mcllwaine, 


E. S. Hawk, Secy, 


H. G. Norton, 


William Elmer, Treas.y 


N. B. Oliphant, 


G. N. J. Sommer, Rep., 


R. H. C. Phillips, 


C. F. Adams, 


William Rice, 


Elmer Barwis, 

• < 

E. H. Rogers, 


H. M. Beatty, 


R. R. Rogers, Jr., 


C. P. Britton, 


R. R. Rogers, Sr , 


A. T. Bruyere, 


G. Schoening. 


F. V. Cantwell, 


George Silvers, 


M. E. Caminade, 


J. B. Shaw, 


W. A. Clark, 


C. Shepherd, 


P. L. Cort, 


I. M. Shepherd, 


H. B. Costill, 


E. B. Skellinger, 


C. J. Cray thorn. 


W. McD. Struble, 


A. H. Dey, 


W. D Stevenson, 


E. L. Dickinson, 


G. E. Titus, 


J. C. Felty, 


L. D. Tompkins, 


G. H. Franklin, Hightstown 

W. B. Van Duyn, 


A. I. Hunt, Hamilton Square 

A. F. Van Horn, 


J. S. Jamieson, 


J. W. Ward, 


Mozart Jenkins, 


David Warman. 

• % 

H. S. Johnson, Lawrenceville 

H. M. Weeks, 


Edward Kelly, 


J. H. WikoflF, 


W. S. Lalor, 

• 4 

Lloyd Wilber, 


C. B. Leavitt, 


W^m. Wilber, 


Lynan Leavitt, 


B. W. McGalliard, 


P. W. Yard, 


No. Members, 57. 




(Society organized June i6, 1816. Meets third Wednesday, Jan., Apr., July and Oct.) 

J. G. Wilson, Preset Perth Amboy C. H. Andrus, Meinchen 

C. M. Slack, V,'Pres., A. C. Hunt, 

Ntw Brunswick E. B. Dana, 


D. C. English, Treas,, 
D. Stephens, Secy, 
A, L. Smith, Pep., 
H. R: Baldwin, 
F. M. Donohue, 
John Helm, 
C. H. Voorhees, 
N. Williamson, 
P. A. Shannon, 

No. Members, 23. 








Wm. V. McKenzie, 
Wm. M. Moore, 
A. Treganowan, 
F. E. Riva, 
J. C. Holmes, 
H. C. Symmes, 
J. L. Suydam, 
J. J. Bissett, 



South Ambpy 




S. V. D. Clark, New Brunswick 


(Society organized July 16, 1816.) 

A. F. Applegate, Englishtown S. F. Macintosh, 

Wm. B. Beach, 
H. G. Cooke, 
J. E. Cooper, 
Ellis Crater, 
J. F. Davison, 
V. M. Disbrow, 
Ed. Field, 
D. M. Forman, 

Eatontown G. W. Mac Mil Ian, 

New Brunswick Wm. Mac Mil Ian, 

Shrewsbury J. G. Maynard, 

Ocean Port Henry Mitchell, 

Asbury Park F. C. Price, 

Lakewood P. B. Pumyea, 

Red Bank Edgar Roberts, 

Freehold Ed. F. Taylor, 

D. D. Hendrickson, Middlctown John Taylor, 

H. A. Hendrickson, C. H. Thompson. 

Atlantic Highlands Fred. Thompson, 

Wm. M. Hepburn, 
A. J. Jackson, 
H. P. Johnson, 
Sam. Johnson, 
W. R. Kinmouth, 
C. Knecht, 
W. U. Kurtz, 
I. S. Long, 

Asbury Park 




Asbury Park 





Asbury Park 



Spring Lake 

Freehold W. W. Trout, 
Matawan J. H. Van Meter, 
Allentown Atlantic Highlands 

Asbury Park W. B. Warner, 

Farming dale Geo. T. Welch, 

Matawan W. S. Whitmore, 

Eatontown G. F. Wilbur, 

Freehold Alex. Williamson, 

Red Bank 


Red Bank 

Asbury Park 





Robert Laird, Manasquan J. B. Goodenough, Long Branch 

J. E. Arrowsmith, Key port 

No. Members, 38. 


(Society organbed June z, 1815.) 

C. N. Miller. Pres. 


A. W. Condict, 


T. P. Prout, V,-Pres., 

R. L. Cook. 


Morris Plains 

T. R. Crittenden, 


L. Farrow, Secy, 

Middle Valley 

G. 0. Cummins, 


J. S. Stiger, Treas, 


H. V. Day, 


E. P. Cooper, Rep, 

, Troy Hills 

Harris Day, 


N. H. Adsit, 


G. S. DeGroot. 


C. Anderson, 


B. D. Evans, 

Mot ris Plains 

S. H. Reed, 


Eliot Gorton, 


P. C. Barker, 


P. S. Mallon, 


L. F. Bishop, 


Jos. R. Farrow, 

German Valley 

G. A. Becker, 


E. Sutton. 


James Douglas, 


F. W. Flagge. 


H. A. Henriques, 


G. H. Foster, 


B. M. Howley, 


W. S. Foster, 


A. A. Lewis, 


H. W. Kice, 

Port Oram 

F. W. Owen, 


J. Walters, 


S. Pierson, 


A. A. Macwithey, 


A. E. Carpenter, 


Wm. H. Risk, 


J. G. Ryerson, 


J. B. Risk, 


J. L. Taylor, 


G. M. Swaim, 


C. Wigg, 


W. J. Wolfe, 


L. W. Case, Montclair, Essex Co, 

H. C. Upchurch, 


L W. Condict, 



C. Y. Swan, Morristown, 

No. Members, 46. 



(Society organized July 14, 1844. Meednga, monthly on Third Tuesday.) 



P. A. Harris, Pres,, 
H. Kip, V.'Pres,, 

C. H. Scribner, Sfc'y, 
Wm. Flitcroft, Treas., 
J. M. Stewart, ^^/., 
W. K. Newton, Censor, 
W. B. Johnson, 
T. J. Kane, 

F. E. Agnew, 
A. Alexander, 
R. R. Armstrong, 

G. H. Balleray, 
J. H. Banta, 
J. W. Atkinson, 
J. S. Bibby, 
W. Blundell. 

D. T. Bowden, 
J. A. Browne, 
V. E. Bullen, 
R. M. Curts. 
S. Dejager, 

E. W. Doty, 
Geo. Fischer, 
T. J. Fitzmaurice, 
O. V. Garnett, 
J. T. Gillson, 
M. W. Gillson, 
W. S. Green, 
J. H. Henggeler, 

A. D. Jousset, 
H. H. Lucas, 
J. L. Leal, 
M. A. Mackintosh, 

B. C. Magennis, 
E. J. Marsh, 











Pater^on A. F. McBride 

£. S. McClellan. 
J. C. McCoy, 
J. R. Merrill, 
S. R. Merrill, 

E. B. Morgan, 
C. F. W. Myers, 
R. Neer. 
W. Neer. 
T. F. O'Grady. 
J. F. O'Donnell, 
H. Parke. 
T. L. Paton, 
J. P. Paxton, 

A. W. Rogers, 

B. H. Rogers, 
J. W. Smith, 

C. Terriberry, 
G. W. Terriberry, 
S. Van Dalsen, 
C. S. Van Riper, 

F. Vigna, 
J. W. Williams, 
W. H. Carroll, 

F. F. C. Demarest, 
J. F. Hadley, 

G. T. Rundle. 
P. H. Terhune, 
R. H. Terhune, 
C. Van Riper, 
G. Van Vranken, 
G. S. Davenport, 
W. R. Smith, 
M. J. Synott, 













J. C. Her rick, Colorado Springs, Col. 
No. Members, 70. 














Little Falls 





(Society organized May 4, 1880.) 

G. W. H. Fitch, Pres,„ Daretown B. A. Waddington, 

W. L. Ewen, V.-Pr^s,, Alloway F. Bilderback, 

H. Chavenne, Sec*y &* Tr^as,, W. H. Carpenter, 

Salem N. S. Hires, 

H. T. Johnson, Refi,, Pedricktown W. S. Patrick, 

W. T. Good, Censor, Quinton L. H. Miller, 







W. H. James. 
Dan'l Garrison, 



Pennsville L. L. Glover, 


B. T. Shinwell, 
H. A. Hare, 

H. M. Christian, 

C. E. TurnbuU, 
Mordecai Price. 
£. B. Gleason, 
James Hunter, 

No. Members, 14. 




Phila, Geo. Friebes, Phila, 

J. F. Hamilton, 
Capt. Chas. Mcllvain, 
R. M. Davis, Camden 

E. E. DeGrofft, 

L. M. Halsey, IVillt'amstown 

Wesiville Howard A. Wilson, Woodbury 




(Society organized May, x8i6.) 

H. G. Wagoner, Pres., Somerville B. B. Matthews, 

S. O.B. Taylor, V.-Pres., Millstone C. R. P. Fisher, 

J. P. Hecht. Sec*y, Raritan F. A. Wild. 

W. H. Merrell. Treas., W. B. Ribble, 

South Branch J. E. Anderson, 

A. L. Slillwell, Rep,, Somerville J. H. Cooper, 

Bound Brook 



Mary E. Gaston, 
W. J. Swinton, 
J. F. McWilliam, 
L. T. Reed 
T. H. Flynn, 





H. V. Davis, 

I. Fischer, 

J. B. Beekman, 

East Millstone 



North Branch 



Peter J. Zeglis, North Plainfield 


John H. Ward, Trenton, 


E. R. Voorhees, M. D. C, Somerville. 
No. Members, 20. 



L. C. Burd, Pres.t 
H. C. Van Gaasbeck. 

S. B. Straeley, Sec'y, 
E. Morrison, Treas,^ 
Bruno Hood, 
Shephard Voorhees, 
P. N. Jacobus, 
Joseph Hedges, 
J. C. Price, 
E. S. Dalrymple, 

E. Schumo, 

No. Members, 20. 


(Society organixed August aa, 1899.) 

Ogdensburg B. W. Ferguson, 
Vice-Pres.^ J. C. Moore, 
Deckertown J. B. Pellet, 
Andaver J. P. Couse, 
Newton Martin Cole. 
** John Strader, 

Jas. N. Miller. 
C. K. Davison, 
Branchville T. H. Andress, 
" J. F. McCloughan, 



Branchville Carlos Allen, 


(Society organized June 7, 1869.) 

E. W. Hedges, Pres,, Plainfield G. W. Endicott. 

J. S. Green, Vice-Pres., Elizabeth E. W. Hedges, 

J» B. Harrison, Secy, Westfield A. Manning, 

R. J. Montfort, Treas., Elizabeth W. H. Murray, 















R. B. Whitehead, Rep,, 

J. H. Carman, 


W. A. M. Mack, 

F. C. Ard. 


A. Pellet, 

B. Van D. Hedges, 


Victor Mravlag, 

M. L. Clowson, 


T. N. McLean. 

W. F. Gaston, 


A. Q. Donovan, 

W. C. Borne, 


N. L. Wilson. 

D. W. C. Hough. 


E. R. O'Reilly, 

W-. U. Selover, 

Edgar B. Grjpr. 

E. Br Silvers, 

W. F. Turner, 

W. E. Cladek. 

T. F. Livengood, 

H. Page Hough. 

G. H. Bridgman, 

John M. Randolph, 

James S. Green, 

William Gale, 


S. J. Keefe, 

J. B. Harrison, 


R. J. Montfort, 

R. R. Sinclair, - 


A. Stern, 


A. H. Scofield. 


J. p. Reilly, 
Thos. Dolan, 
R. B. Whitehead. 
F. R. Bailey, 
T. F. Burnett, 
J. H. Keenan, 
J. B. Probasco, 
T. H. Tomlinson, 
M. B. Long, 

No. Members, 58. 





J. K. McConnell, Cranfard 

C. Wilbur McConnell, 




J. H. Coles, 
F. W. Westcott. 
F. M. Corwin, 
H. C. Pierson, 
Plainfield G.W.Strickland, 
J. R. English, Jr., 
T. J. Jackson, 

Scotch Plains 


Bergen Point 







(Society organized February 15, 1826. 

G. W. Cummins, Pres,, Belvidere 
F. C. Curtis, Vice-Pres,, 

W. J. Burd, Sec'y^ Belvidere 

Wm. H. McGee, Treas,, " 
J. H. Griffith, Rep., Phillipsburg 
Isaac Barber, 
A. P. Jacoby, 
Wm. Kline, Jr., 
J. M. Reese, 
John C. Johnson, 

No. Members, 20. 






Annual meeting first Tuesday in June.) 

H. O. Carhart, Blairstown 

John S. Cook, Hackettstown 

Louis C. Osmun. ** 

Alva C. VanSyckle, 

C. B. Smith, Washing fon 

Wm. Stites, 

Wm.C. Albertson, Belvidere 

M. N. Armstrong, Newton 

L. C. Osmun, Washington, D. C, 

G. O. Tunison, Oxford 




- 24 





Monmouth, - 

- - 38 


- 29 


- 46 




- 70 

Cape May, 

- 19 






- 20 

Essex, - 

- - 183 






- - 58 


- 59 





Mercer, - 

- 57 




Medical Society of New Jersey. 

One Hundred and Thirty-First Annual Meeting. 

Atlantic City, June 22 and 23, 1897. 


The meeting was called to order at 12. lo p. m., in the 
Ball Room of the United States Hotel, by the President, 
Dr. T. J. Smith, of Bridgeton. Prayer was offered by 
Rev. W. M. White, of Atlantic City. 

Dr. Alex. McAlister was appointed a member of the 
Committee on Credentials; also Assistant Secretary, 
pro tem. The report of the Committee on Credentials 
was read by the Secretary, Dr. William Pierson : 

The Committee on Credentials would respectfully present the 
accompanying roll prepared from the certificates received from the 
various District Societies in the State, as its report on annual delegate 
members. Certificates were found to be in accordance with the pro- 
visions of the by-laws. No certificates were received from Glouces- 
ter and Ocean Counties. 

The District Societies of Hudson and Ocean have not paid their 
dues, therefore are not reported. A certificate in due form, has been 
received from the Somerset District Society, placing Dr. S. O. B, 
Taylor in regular nomination for permanent delegate, to fill the 
vacancy occasioned by the resignation of Dr. C. R. P. Fisher. The 
Committee recommend his election. 


The resignation of Dr. Virgil M. D. Marcy, of Cape May City, as 
permanent delegate is in the hands of the Committee. We recom- 
mend that it be accepted. 

Wm. Pierson, 

Alex. McAlister, 
Atlantic City, June 22. 1897. Archibald Mercer. 

On motion, the report was accepted. 
The Secretary called the roll. 

Atlantic — E A. Reiley, W. Blain Stewart, Walter Reynolds. Board- 
man Reed. Corresponding members, E. Marvel, I. B. Thompson. W. 
E. C. Chew. Members, 24 

Bergen— Y), A. Currie, J. W. Terry,* D. St. John,* S. E. Armstrong,* 
H. M. Banks.* Members, 25. 

Burlington — Y, G. Stoud. A. H. Small. Francis S. Janney, I. W. 
Hollingshcad. Emma P. Weeks. E. Hollingshead. Members. 29. 

Camden —Daniel Strock, A. McAlister, W. G. Bailey. S. G. 
Bushey. W A. Westcott,* F. L. Horning. W. H. Iszard, J. F. Leavitt, 
Max West, D. Benjamin. Sophia Presley, cor. member. Members. 70. 

Cape il/tf^— Randolph Marshall. Eugene Way, I. M. Downs,* W. 
A. Lake.* Members, 19 

Cumberland — E. Stites, D. H. Oliver, A. W. Sullivan, C. J. Massin- 
ger, A. R. Judson, S. T. Day. Members. 34. 

Essex— C D Bennett, R. C. Newton, C. Lehlbach, E. Fayette Smith, 
M. H. Simmons,* J. W. Stickler, L. E. Hollister, W. F. Seidler, J. D. 
Osborne, M. Runyon, R. H. Rogers,* M. N. Robinson, W. Penning- 
ton, Anna L. Smith.* H. P. Roden,* W. F. Shiek,* F. W. Thum, C. 
A. Schureman,* G. W. Rolerfort, W. D. Robinson,"^ S, E. Robertson,* 
P. Ricord.* Members, 183. 

Gloucester — Harry A. Stout. E. T. Oliphant, James Hunter, H. A. 
Wilson. H. B. Diverty. Members, 22. 

Hudson — J. M. Rector,* J. E. West,* C, F. Kyte,* John J. Broderick,* 
C. D. Hill,* G. E. McLaughlin,* T. R. Chambers, S. A. Heifer,* F. M. 
Corwin,* I. N. Quimby, cor. member. Members, 59. 

Hunterdon— \, S. Cramer, W. S. Creveling, W. E. Cornog,* F. L. 
Johnson,* A. B. Nash, E. H. Moore, alt. Members, 17. 

Mercer — W. A. Clark,* E. Barwis, F. V. Cantwell, T. H. McKenzie, 
H. G. Norton,* Wm. L. Wilber, C. F. Adams, W. McD. Struble. 
Members, 57. 


Middlesex — ^J. L. Suydam * A. L. Smith,* E. B. Dana,* J. C. Holmes,* 
J. G. Wilson.* H. G. Cooke, cor. delegate. Members, 23. 

Monmouth — C. Knecht, W. U. Kurtz, E. Crater,* V. M. Disbrow. 
G. F. Wilbur,* A. F. Applegate.* Members, 38. 

Morris — H. V. Day,* B. D. Evans„ G. O. Cummins, J. Douglas,* 
C. W^igg, H. W. Kice,* F. W. Flagge,* Louis F. Bishop. Members, 46. 

Passaic—]. R. Merrill, J. A. Browne,* R. M. Curts, Geo. Fischer.* 
T. J. Kane.* M. A. Mackintosh,* J. C. McCoy.* B. H. Rogers,* C. H. 
Scribner, G. Van Vranken.* Members, 70. 

Salem — B. A. Waddington, W. L. Ewen, W. H. James, D. Garri- 
son, L. H. Miller.* Members, 14. 

Somerset — Mary E. Gaston, J. H. Cooper,* J. E. Anderson,* I. 
Fischer,'*^ J. P. Hecht. Members, 20. 

Sussex — T. H. Andress,* H. C. Van Gaasbeck,* J. P. Cbuse* 
Bruno Hood,* P. N. Jacobus.* Members, 20. 

Union — John P. Reilly, J. B. Harrison.* N. L. Wilson.* E. R. 
O'Reilly,* B. Van D. Hedges. W. U. Selover,* M. B. Long.* J. H. 
Carman.* Members, 58. 

Warren—]. M. Reese, L. C. Osmun,* C. B. Smith, L Barber, Wm. 
Stites * Members, 20. 


Pesident, Dr. T. J. Smith ; Vice-Presidents, Drs. D. C. English, 
C. R. P. Fisher, L. M. Halsey ; Corresponding Secretary, Dr. E. L. B. 
Godfrey ; Recording Secretary, Dr. William Pierson ; Treasurer, Dr. 
Archibald Mercer ;, Standing Committee, Drs. H. W. Elmer, H. 
Mitchell, M. Lampson, Chas. Young, W. H. Iszard. 


Drs. Franklin Gauntt, Henry R. Baldwin. John S. Cook, Alex. W. 
Rogers, John W. Ward, H. Genet Taylor, Elias J. Marsh, John G. 
Ryerson, O. H. Sproul, Wm. Elmer, Charles J. Kipp. 


Henry C. Neer, James M. Ridge, W. H. C. Smith, Charles Young, 
John H. J. Love. Arthur Ward, Isaac S. Cramer, Cornelius Shepard, 
Henry Mitchell, Henry C. Cooke, L W. Condit, John Stiger, W. B. 
John"son, H. G. Wagnor, P. A. Harris, Geo. Evans Reading, B. A. 



Waddington, W. H. Vreeland. O. B. Gross. D. W. Blake. N. Newlin 
Stokes, Levi Farrow, George C. Laws, R. R. Rogers, Sr., William H. 
Ireland, William J. Chandler, Edward J. Ill, George H. Balleray, 
William S. Creveling. George Bayles, William H, McGee, S. O. B. 


Drs. Wm. Edgar Darnall, D. Strock, Julius Way, J. C. Applegate, 
C. S. Heritage, G. N. Best, G. N. J. Sommer, A. L. Smith, E. P. 
Cooper, W. L. Ewen, A. L. Stillwell, Sidney B. Strailey, B. White- 


Pennsylvania, W. B. Atkinson, M.D. and Edward Jackson, M.D.; 
New York, E. M. Morrell, M.D.; New Jersey Pharmaceutical Associ- 
ation, W. J. Harrison and H. H. Deakyme. 

Hon. Frank P. Stoy, Mayor of Atlantic City, delivered 
an address of welcome. He said : 


Mr, President and members of the Medical Society of New Jersey : 

I assure you that it is a pleasant duty for me to welcome to our 
city this honorable body. I understand that you have, on several 
occasions before, been here in the same capacity, and if so no doubt 
you have had proof of a hearty welcome. We hope you will always 
feel at home with us. I extend to you a cordial welcome, the hospi- 
tality and freedom of the city, and trust that your meeting will be one 
of great importance to you and a benefit to ihe State. You are 
thrice welcome. 

Dr. Boardman Reed read the report of the Committee 
of Arrangements. 

Your Committee of Arrangements beg to submit the following 
report : 

In obtaining a special extra train from Philadelphia over the 
Camden and Atlantic Railroad at the usual excursion rate and at an 
hour convenient to most of the delegates, we have accomplished all 
that was possible in the way of concessions from the railroad 
companies, and probably all that we had a right to expect, consider- 
ing the comparatively low fares now prevailing on the various New 
Jersey lines. 

MINUTES. . 31 

Free transportation to Longport and return is to be given also to 
^s many of the members and their accompanying ladies as may desire 
to make the excursion. 

The place of meeting selected is one with which you are already 
familiar, the Society having met in the same house five years ago and 
^ound it in most respects admirably adapted to the purpose. This 
•commodious assembly room which has since then been added to the 
''building is a great improvement upon the dining room in which the 
sessions had to be held before. 

At the two former meetings of the Society in Atlantic City, 
complaint was made that the Committee of Arrangements provided 
^uch a superabundance of attractive entertainments as to interfere 
Avith the consideration of papers and other necessary business. We 
have therefore endeavored this time to impose upon ourselves and 
upon the hospitable citizens of Atlantic City generally, a certain 
amount of restraint and not to do our very best in the way of helping 
you to enjoy your sojourn in this greatest of American health and 
pleasure resorts. For instance, no banquet will be given and no free 
yachting parties or carriage rides will, as on former occasions, 
tempt you away from the paths of duty during the time of the sessions. 
The Government Life Saving Service will not give an exhibition of 
how they rescue the crews of stranded vessels at a time when you 
ought to be consulting together concerning the best methods of 
^saving lives from the demon of disease. But during the intermission 
-of serious work you will find no lack of diversion. 

If any of you yearn for a dip in the breakers, old ocean stands 
ready to receive you, and sturdy life guards provided by the city, will 
be on hand to pull you out when you get beyond your depth. If you 
Tieed exercise you can enjoy a three mile walk on the grandest ocean 
promenade to be seen anywhere in the world, and will see en 
j^oute a large modern up-to-date hotel on nearly every block of the 
entire distance, besides innumerable other buildings devoted to the 
entertainment and comfort of visitors. If you would prefer to inspect 
the streets, drives and fine buildings in the business quarters and 
suburbs, you will find very much to attract and interest you, and 
those of you who have not been here since the meeting of five years 
ago, will need a guide to pilot you around in the newer parts. 

In honor of the coming of the Society, the following places of 
amusement will, through the liberality and public-spirit of the pro- 


prietors, be open today and tomorrow to all delegates, visiting 
physicians and accompanying ladies who shall wear the badge that 
has been provided by the committee for them : The Brighton Casino ; 
Young & McShea's Pier ; The Somers Casino Company ; Merry-Go- 
Round ; The Japanese Tea Garden, and Albrecht's Music Hall. 

A reception will be given this afternoon from 3 to 5, and this even- 
ing from 9 to II, at the residence of the Chairman of the Committee 
of Arrangements and of his partner. Dr. W. Blair Stewart, comer of 
Pacific and North Carolina avenues, to which all in attendance upon 
the meeting are cordially invited. Cards of invitation to this reception 
will be furnished at the rooms of the committee in this building. 

Through the courtesy of the Pennsylvania Railroad Company, dele- 
gates and their families are also invited to join in an excursion to 
Longport over the electric railway tomorrow afternoon at 4 o'clock. 
Special cars will start from the corner of Atlantic and States avenues, 
near this hotel. 

The two days to which the meetings of the Society are limited will 
be all too short to permit of your sampling even one-tenth of the 
attractions which Atlantic City has to offer, but your only recourse 
will be to remain over for a week after the adjournment in order to 
enjoy such a vacation as cannot be had anywhere else. 

On motion, it was accepted with thanks. 

The Secretary, Dr. Pierson, read an abstract of the 
minutes of the last annual meeting. On motion the 
minutes as published in the Transactions were adopted as 
the minutes of the last annual meeting. 

On motion, the Society proceeded to the election of 
permanent delegates. There being but one name before 
the Society, Dr. Chandler moved that the Secretary cast 
an affirmative ballot for the Society for Dr. S. O. B. 
Taylor, of Somerset. Carried. Dr. Pierson cast an 
affirmative ballot and Dr. Taylor was declared elected. 

The report of the Committee on Business was read by 
Dr. H. R. Baldwin, Chairman of the Committee : 


Gentlemen of the New Jersey State Medical Society : 

In making the annual report, your Committee on Business would 
congratulate you upon the very full programme presented for your 
consideration and discussion, as appears upon the printed schedule. Dr. 
Iszard's subject changed to Aphorism in Medico-Legal Testimony. 
It would greatly facilitate the labors of the Committee if earlier 
communication of themes of papers were forwarded to the Chairman, 
many coming in at the last moment and others necessarily refused 
because too late. 

The Committee having learned that Dr. H. M. Weeks is ill and unable 
to be present, they would ask that the paper of Dr. J. W. Stickler 
tipon " Scarlet Fever Reproduced by Inoculation and some Import- 
ant Facts deduced therefrom," be inserted in that order. 

The subject submitted for discussion at your coming meeting is 
" Milk as a Culture Medium and its capacity to spread Infectious 
Diseases." With this report your Chairman would respectfully 
request that in the formation of your Committee for the coming year, 
the name of the chairman be dropped from the list of nominees. 

Respectfuly submitted, 

Henry R. Baldwin, Chairman, 
Walter B. Johnson, 
e. hollingshead. 

It was received. 

Dr. D. C. English moved that the Rev. W. M. White 
and Mayor Stoy be invited to sit as corresponding 
members. Carried. 

All delegates from corresponding societies and mem- 
bers of the profession of this State who may be present, 
were invited to seats as corresponding delegates. 

On motion, the rules were suspended and the report 
of the Committee on Ethics and Judicial Business was 
postponed until after recess. 

The report of the Treasurer was read by Dr. A. Mercer. 
On motion of Dr. Pierson, the report was accepted and 
the action of the Treasurer in borrowing money was ap- 
proved. Referred to Auditing Committee. (See Appen- 



Dr. A. Mercer moved that the following bills be paid. 

Dr. Godfrey, Corresponding Secretary $20.95 

Dr. Pierson. Recording Secretary 1 5.7$ 

Dr. Mercer, Treasurer 14.18 

L. J. Hardham 128.00 

Orange Chronicle ... 16.50 

R. C. Shultz, Stenographer 50.00 

The report of the Corresponding Secretary was read 
by Dr. E. L. B. Godfrey. On motion, it was received. 
(See Appendix.) 

The President appointed Drs. H. R. Baldwin, L. E. 
HoUister and D. W. Blake, Sr., to audit the Treasurer's 

Dr. H. G. Taylor, Chairman of the Committee on 
Honorary Membership and Honorary degree of Doctor 
of Medicine, reported that no name had been before the 

Dr. William Pierson nominated Dr. Samuel H. 
Pennington, of Newark, one of the oldest members of the 
Society, for honorary member. The nomination was re- 
ferred to the Committee. 

The report of the Committee on Legislative Action on 
Bovine Tuberculosis, was presented by the Chairman of 
the Committee, Dr. J. W. Stickler: 

The Committee had been able to accomplish only a limited amount 
of work during the year. It was hoped some time to have their bill 
passed by the legislature, relating to bovine tuberculosis. In order to 
show how necessary was this work, a few statistics were cited of the 
number of deaths in different parts of the State from pulmonary 
consumption during the past year. In Camden County, 208 ; Essex, 
733 ; Hudson, 808 ; Passaic, 289, or a total throughout the State 
of 3358 — a good sized community if all could be called back again. 


The deaths in the various cities have been 2228, against 1 1 30 in the 
country districts. There were 1572 females and 1786 males; more 
males than females. Now that is a bad showing for a State whose 
population is estimated at less than two millions. 

I think an effort should be made for a committee of this Society to 
cooperate with State Board of Agriculture, the State Board of 
Health, and the Board of Dairy Commissioners, and try to secure 
such legislation as will tend to the eradication of this horrible disease, 
tuberculosis, from the State. 

Dr. Charles Young, of Newark, offered the following 
resolution (continuing the Committee, etc.) which was 
adopted : 

Moved, That the Committee on Legislative Action on Bovine 
Tuberculosis be continued, and that said Committee be requested to 
cooperate with the authorities of the State having charge of the 
diseases of animals, including the Tuberculosis Commission, State 
Board of Health and State Dairy Commission, for the purpose of 
securing some more effectual measures than those which now exist 
for the eradication of Bovine Tuberculosis in this State. 

Dr. Reading moved that the President appoint a mem- 
ber to fill the vacancy in the Committee on Legislative 
Action on Bovine Tuberculosis. The motion carried, 
and later the President appointed Dr. Henry Mitchell. 

The Society took a recess until 3 p. m. 

The Society was called to order at 3 p. m. by the 

The report of the Committee on Ethics and Judicial 
Business was read by Dr. H. W. Elmer, and on motion was 
received : 

The Committee on Ethics has received a paper signed by the 
Secretary of the District Medical Society of the County of Union, 
relating to medical services, which, it is stated, are rendered under 
contract in said Society. 


No evidence accompanies the paper to show that any controversy 

exists between the members of the said District Society in relation to 

the question referred to in said paper, and the facts bearing upon the 

statement contained in said paper are not set forth with sufficient 

clearness to warrant action by this committee, as no breach of the 

Code of Ethics has been discovered. 

H. W. Elmer, 

Henry Mitchell, 

M. Lampson, 

Chas. Young, 

Wm. H. Iszard, 

Stephen Pierson, 

June 22, 1897. Committee, 

The report was accepted. 

Dr. D. M. Skinner read the following report: 

The committee appointed at the last meeting of the Society, to urge 

upon the legislature the granting of an appropriation sufficient to 

maintain the Bacteriological Laboratory at Princeton, respectfully 

reports that it has performed its duties. The legislature has voted 

such an appropriation. 

Respectfully submitted, 

D. M. Skinner. 

H. Genet Taylor. 


Report accepted with thanks and the Committee 

Dr. E. L. B. Godfrey called attention to the omission 
of the following by-law from the printed by-laws: 

Sec. IV. — The names of all permanent delegates who may have 
died shall be reported to the Corresponding Secretary by the Secretary 
of the Society of which they were members, and the Corresponding 
Secretary shall in turn report them to the Medical Society of New 

He requested that the error be corrected. 

The President stated that the omission of publication 
did not invalidate the by-law, and it would be placed 
upon the record as part of the by-laws. 


The report of the Standing Committee was read by 
Dr. H. W. Elmer. The other members of the committee 
read papers as follows : 

Dr. Charles Young, on ** Surgery." 

Dr. Henry Mitchell, on ** State Medicine and Hygiene." 

Dr. E. Fayette Smith, on ** Treatment of Diseases of 
the Nose and Throat." 

Dr.T. R. Chambers, on " Progress of Therapeutics of 
the Eye and Ear." 

Dr. William H. Iszard, on " Medico-Legal or Expert 

On motion, the report and papers were accepted and 
referred to the Committee on Publication. 

The Auditing Committee, through Dr. H. R. Baldwin, 
reported as follows : 

Your Committee find Treasurer's account correct, and vouchers 
furnished for all expenditures. 
The assets of the Society are : 

U. S. 45^ Bonds, $2,250.00 

Cash in hand, - - - - - - - 818.98 

Total, $3,068.98 

The present indebtedness, $1,127,21, made up as follows: 

Note to Howard Savings Institution, Newark, - $850.00 

Current Expenditures, ------ 277.21 

Total debt, $1,127.21 

Henry R. Baldwin, 
l. £. hollister, 
Duncan W. Blake, Sr. 

Auditing Com, 

On motion, the report was accepted with thanks and 
the Committee discharged. 

Dr. A. Mercer said, " that in failing to make any recom- 
mendation for an assessment, the Auditing Committee 
had failed to provide any means for paying off the in- 


debtedness of the Society, about $1,127. There is a note 
for $850 which is now due. We have received $760 from 
various district societies. Our current expenses, amount- 
ing to about $227, ought to be paid. This deficiency 
must be met in some way. An assessment on the district 
societies will not be met till next June. There are but 
two ways of meeting the dilemma : One is to sell one 
thousand dollars in United States Bonds, the other to 
borrow a thousand dollars on note. If we borrow we will 
have to pay six per cent, interest. Our U. S. Bonds are 
paying us four per cent. They are today worth about 
$120, but they mature, I think, in 1907, and will begin to 
depreciate in value as the time of maturity shortens. If 
today we sell a bond of a thousand dollars our premium 
will amount to $200, and including the difference in rate 
of interest, we will thus lose $220 by borrowing on note. 
Therefore I move that the Society sell one one-thousand- 
dollar bond, and also that the assessment on the district 
societies next year be two dollars.** 

Dr. Lampson moved that the motion be divided. 

Dr. Mercer explained why it was impossible in 
advance, to estimate what would be the cost of printing 
the Transactions, and why the cost varied each year. 

Dr. H. R. Baldwin said that the position which he had 
taken the last fifteen years was that we should have an 
invested fund. There were gentlemen present who could 
recall the contest which they had passed through when 
an attempt had been made to use that fund for a different 
object from that which it was originally designed — to aid 
in the publication of the Transactions. He felt that one 
of the incentives for our coming together with some 
degree of cohesion was the publication of an annual 
volume of Transactions, and it was desirable to retain the 
premanent fund which, if increased in the future, would 


meet that expense. It was bad policy to invade the in- 
vested funds. It was easy to have them slip away ; it was 
very hard to get them together. He had himself worked 
for eleven years as Treasurer of the Society to get them 
up to nearly two thousand dollars. He would prefer to 
see the assessment placed at three dollars a member for a 
year or two, until the debt was paid, in order that the 
vested funds might remain intact. Had it not been for 
the bonds owned by the Society and accepted as security, 
money could not have been borrowed with which to pay 
for the publication of the Transactions the past year. 

Dr. Shepherd, of Trenton, hoped the Society would 
heed Dr. Baldwin*s suggestion, and . under no considera- 
tion, consent at the present time to invade the perma- 
nent fund which the older members remenibered had 
been raised with such difficulty when Dr. Baldwin was 
Treasurer. It would be better to increase the assessment 
and add to that fund rather than invade it. 

Dr. Neer said the permanent fund had been raised by 
the district societies and paid to the State Society for a 
specific purpose, and it was a question whether this 
Society was authorized to use the money for any other 
purpose. It had been raised to create a fund the interest 
of which should be used for printing the Transactions of 
the Society. It would be better to pay a somewhat 
larger assessment a few years and allow the permanent 
fund to attain to an amount which would provide every 
member of the district societies with a volume of the 

Dr. D. C. English agreed fully with Drs. Baldwin, 
Shepherd and others who had opposed invading the perma- 
nent fund, but he thought the difficulty had arisen from 
a mistaken policy the past few years of dropping the 
assessment. Let this experience teach us a lesson. The 


expenditures the past year had been unusually large 
because of the size of the volume of Transactions, which 
contained from 75 to 100 pages more than some previous 
years when no historical sketches of counties had been 
published. It was a question in his mind whether the 
Society ought to publish the transactions of the county 
societies on anniversary occasions. But that had been 
the policy in past years, and that was the reason why the 
Transactions the past year had cost $1,100 instead of $700. 

The President put Dr. Lampson's motion to divide the 
question, and it carried. 

Dr. Mercer remarked that a permanent fund large 
enough that the interest on it might pay for publishing 
the Transactions would have to amount to twenty or 
twenty-five thousand dollars. From time to time. Audit- 
ing Committees had objected to making assessments on 
the district societies, so that one year an assessment would 
be levied and another year it would not. The argument 
had been advanced that there was no reason why the 
present members of the Society should accumulate a fund, 
the interest of which should pay the dues of future 

The President put the motion to sell one one-thousand- 
dollar bond. The motion was declared lost. A standing 
vote was called for, and the motion was declared lost. 

The motion to make the assessment for the current 
year two dollars, carried. 

Dr. William Pierson moved that the Treasurer be em- 
powered to make a temporary loan to meet existing 
obligations, and offer bonds in security. Carried. 

The Secretary read a communication from the Secre- 
tary of the American Medical Association relating to the 
Rush Monument Fund. 


Resolved, That the Secretary be instructed to request each State 
Medical Society to appoint a committee to take charge for that State 
of the raising of, a fund of $100,000 for the Rush Monument Fund. 

On motion the Society adjourned, to meet at 7.45 p. m. 


The meeting was called to order at 8.13 by Dr. D. C. 
English, first Vice-President. 

The President, Dr. T. J. Smith, read his annual address, 
entitled, ** The Problem of Dependency." 

Dr. E. J. Marsh moved, that a vote of thanks be ex- 
tended the President for his address, that a copy be re- 
quested for publication in the Transactions, and that the 
suggestions relating to a colony of epileptics be referred 
to a committee of five, to report to the Society at its 
next annual meeting, and with power to present the 
matter before the legislature in their own discretion. 

Dr. E. L. B. Godfrey seconded the motion. He had 
been forcibly impressed by the address, and with the 
duty of the Society which it had pointed out, to urge 
the founding of an epileptic colony. He felt sure that if 
the matter were presented with such force before the 
Governor as well as before the legislature, ample provision 
would be made to carry out the excellent suggestions 
contained in the address relating to State care of epilep- 
tics. All who were familiar with the history of the 
Society knew that it was in this Society the suggestions 
arose which had led to such magnificent asylums for the 
insane in this State. The Society should also take the 
initiative and present such facts before the legislature as 
would lead speedily to an appropriation for the care of 
the epileptics. 

Dr. Glover said he had only one objection to the 



motion, and that was that it called for too small a com- 
mittee. He was himself in charge of a school for the 
feeble minded in which there were many epileptics, and 
had had exceptional opportunity to learn of their needs and 
requirements. In the State of New Jersey, 'where there 
were so many physicians, a committee of five was entirely 
too small to go before the legislature in a matter of such 
importance as this. It required aggressive action. He 
thought there should be a member on the committee 
from each county who should see the members of the 
senate and assembly from their respective counties. 

Dr. I. N. Quimby said that if there should be a failure 
in the matter it would be because of failure to make the 
public understand the necessity for the appropriation. 
The Governor would not have vetoed the appropriation 
of the last legislature had he been better informed on the 
subject. He knew that to be a fact. 

Dr. B. D. Evans thought the motion was a very appro- 
priate one, and that this Society could not take too active 
an interest in the matter. Something should be done to 
show that the Society was united in its feelings. He had 
been told that only a small appropriation had been asked 
for, that a small colony could first be established, the 
patients be properly drilled and educated, and become 
themselves the educators of others who might enter when 
the funds would permit. He had the pleasure of the 
acquaintance of Dr. Spratling, and understood that such 
was the course being pursued at the Craig epileptic 
colony. There were many epileptics under his care in 
the asylum for the insane at Morris Plains, and he could 
testify to the fact that epileptics were disorganizers to 
the management of an asylum. They excited other 
patients when their paroxysms came on. He heartily 
endorsed Dr. Marsh's motion. 


Dr. Walter B. Johnson thought it had been shown 
conclusively that epileptics were disorganizers to asylums 
for the insane, and that these institutions ought not to be 
burdened with them. A working committee, one which 
would push the matter, should be appointed to hasten 
the formation of an epileptic colony under State care. 

The Chairman, Dr. English, put Dr. Marsh's motion, 
and it was adopted unanimously. 

Dr. English appointed the following as the comfnittee : 
Drs. P. C. Barker, T. J. Smith, John W. Ward, B. D. 
Evans and C. Shepherd. 

Dr. Silvers, of Rahway, presented his report as delegate 
to the Medical Society of New Hampshire, and on 
motion, it was referred to the Committee on Publication. 
(See Appendix.) 

Dr. L. F. Bishop, of New York, read a paper, *' Some 
Important Points in the Treatment of Pneumonia.'* 

Dr. B. D. Evans presented numerous pebbles, spoons, 
etc., which had been swallowed by an inmate of the 
Morris Plains Asylum, and read the history of the case. 

Dr. H. R. Baldwin mentioned a case in which a young 
lady swallowed a breastpin, and another case in which 
about six hundred needles were swallowed and penetrated 
into various portions of the body. 

The President announced the following committees: 


Bergen, D. A. Currie ; Burlington, E. Hollingshead ; Camden, 
M. West ; Cape May, Eugene Way ; Cumberland, S. T. Day ; Essex, 
Wm. J. Chandler ; Gloucester, Geo. E. Reading ; Hudson, T. R. 
Chambers; Hunterdon, E. H^ Moore; Mercer, T. H. McKenzie; 
Middlesex, H. R. Baldwin ; Monmouth, Henry Mitchell ; Morris, 
C. Wigg; Passaic, W. B. Johnson; Salem, D. Garrison ; Somerset. 
A. L. Stillwell ; Union, B. Van D. Hedges; Warren, C. B. Smith. 

The Society adjourned until June 23. 



The meeting was called to order by the President, at 
9.15 a. m. 

Dr. Richard Cole Newton read a paper, " A Criticisn> 
of Modified Milk and of Present Dairy Methods.*' On 
motion, the author was extended a vote of thanks, and a 
copy of his paper was requested for publication in the 
Transactions. Somewhat later it was discussed by Drs. 
H. R. Baldwin, Chambers and Hedges. 

Dr. H. R. Baldwin : " I have been exceedingly grati- 
fied by this presentation of the subject by Dr. Newton. 
I do not think he has exaggerated its importance in the 
least. If we wished to consider some of the evils con- 
nected with dairies, I could take you to a shed on the 
outskirts of this town, or any other town, where there 
are collected some twenty cows, the board floor of the 
shed covered and filled with refuse, the milkmen wearing 
garments which are disordered and by no means clean^ 
carrying on the process of milking without washing the 
cow's udder. When one sees this and much more, he 
can easily understand why the milk contains as many as 
fifty kinds of bacteria. Indeed, more than fifty vari- 
eties of bacteria have been found to come from the cow's 
teat alone. We should be the more interested in this 
paper, since the subject for discussion next year will be, 
' Milk as a Culture Medium and its capacity to spread 
Infectious Disorders.' If the gentlemen present will 
consider the facts presented in this paper and in reports 
from Cornell, Amherst, Rutgers colleges, and in other 
publications, and add to the information thus gathered 
the results of their own observations, they will be pre- 
pared to come to the Society next year and add valuable 
and interesting contributions to an important subject." 


Dr. Chambers: **It seems to me that one point 
which Dr. Newton brought out is especially of practical 
value, namely, the souring of milk in the process of 
churning which it undergoes when being carried about in 
cans. Since I moved from East Orange, where I used to 
certify milk in bottles, the New York Condensed Milk 
Company has supplied me with milk in bottles, and I am 
convinced that the milk bottled at the dairy has less 
churning during transportation than that put in cans, 
that it is usually purer, keeps better, is less likely to sour 
than milk dipped out of the can in stores or when carted 
about to houses. I think that if the Society could give 
its mark of approval to that way of handling milk, it 
would be one step in advance.'* 
. Dr. Hedges: "With regard to the use of modified 
milk, and particularly that from the Gordon-Walker 
laboratory, alluded to in the paper, I believe an advantage 
of milk from that laboratory lies in our ability to regu- 
late the percentage of albuminoids. Too large a percent- 
age of albuminoids is, I think, the starting point of many 
gastric disturbances in children. It has been my custom 
to start off with one-half of one per cent, and gradually 
increase to one per cent, as the child grows older. I 
believe the method is rational, scientific and has come 
to stay. 

**A few words with regard to milk as a medium for 
carrying germs. When I left home there had been 
reported to the Board of Health at Plainfield, about 
sixteen cases of scarlet fever. It was found on investiga- 
tion by the Board of Health that ten of the families 
procured their milk from one source, and further investi- 
gation brought out the fact that this milkman had in his 
employ a young man about sixteen years of age who has 
scarlet fever now in the stage of desquamation. Further, 


two of the milkman's children have scarlet fever. This 
man supplied not only a large part of the families with 
milk, but also a drug store where the milk is used for 
* milk shakes.* ** 

Dr. G. H. Balleray, of Paterson, opened the discussion 
of the subject presented at the last annual meeting, "In 
the Treatment of Appendicitis is the Free Use of the 
Knife Necessary?** with a paper. (See Appendix!) The 
discussion was continued as follows : 

Dr. H. R. Baldwin : ** I hope the subject will not go 
by without some one speaking upon it. I consider that 
in its present aspect before the profession the question is 
one which the surgeon has largely appropriated to him- 
self, and I was glad to hear Dr. Balleray say that it does 
not belong exclusively to the surgeon, but that the 
physician has a place in considering appendicitis. The 
first thing which should arise in our minds when called to 
a case of appendicitis is, of course, the diagnosis. After 
the diagnosis the next question which arises, is, how far shall 
this case be trusted to the natural powers, aided by medica- 
tion, or how soon shall it be interfered with by the knife? 
Those who practiced twenty-five or thirty years ago — it was 
about then that appendicitis was recorded in our nosology 
as a distinct affection — knew nothing of the appalling 
amount of death attributed in the press today to appen- 
dicitis. You may say no diagnosis was made. That is 
quite possible ; still I think that during the earlier years 
the surgeons were not so prone to interfere with the 
knife as they have been more recently. It has even 
been stated that it would be entirely appropriate that an 
operation should be performed on all young men so that 
they may have no appendix to become diseased, just as I 
have heard stated upon this floor that all cases of phi- 
mosis should be operated upon in infancy. I believe this 
last view has never gained much ground. 


* It has been my fortune to see a number of cases of 
appendicitis in which the nature of the disease was 
recognized. I remember the case of «a boy some years 
ago who was supposed to have what was termed * worm 
fever.' When I was asked to see the child, I called at- 
tention to the fact that some pus issued from the umbil- 
icus, and there came out of the pus sinus a stick. That 
child is now a man. 

** Many years ago a man had an attack of appendicitis. 
Leeches were applied ; he was put upon Indian mush 
exclusively inside, and Indian mush or flaxseed outside. 
These were accompanied by calomel and opium and 
other agents apparently indicated in the case. The man 
recovered without an abscess. The next case of which I 
made a note was in a patient over forty years of age, 
treated in a similar way ; cured. No recurrence in either 
instance. Another case occurred in my own son. A 
tumor formed in the usual locality. My friend, Dr. 
Henry B. Sands, came to open the abscess. He did cut 
down through the cellular tissue, through the muscles 
until he came to the fascia transversalis, when he felt 
uncertain as to the adhesion and delayed. Two days 
later the abscess broke into the intestine and finally also 
opened externally. The patient made a good recovery 
and has attended the meetings of this Society for many 
years. Another case was in a young man of about thirty 
in whom an abscess formed. It was opened, but not 
until it had become very apparent, and the patient 

"Another case was that of a man about fifty years 
of age whom I was asked to see in consultation. The 
doctor said he was giving the patient milk and applying 
poultices externally, and giving some antipyretics. I 
told him to poultice him inside. How? Feed him mush. 


The patient took mush exclusively and recovered without 
an abscess. A young man about twenty-two years of 
age was treated .in the same manner; a large tumor 
formed ; he ate mush ; recovery. A young man, sixteen 
or eighteen years of age, had appendicitis, very marked. 
A poultice was applied, calomel and opium were given ; 
he recovered and has had a recurrent attack. On both 
occasions he was fed on mush. Another case was in a 
patient who came to the hospital from Amboy. An 
abscess had already formed ; it was opened ; he got well. 
Another man treated in Rhode Island, 1891, recovered. 
He had a slight recurrent attack, and under the influence 
of mush and poulticing he got well. 

**With these cases I record two fatal ones. One of 
gangrenous appendicitis in a patient who had sustained 
violent traumatism. The other case, which occurred 
many years ago, was in a boy who, no doubt, had suppu- 
rative appendicitis, and died of peritonitis associated 
with it. 

•* Now, here is a record of twelve cases, most of 
which recovered without an early operation, and I think 
in view of these facts that we may well consider whether 
an early operation is so imperative as has been suggested 
by some, and whether we may not better wait a time to 
see whether the patient can not be saved without opera- 

Dr. I. N. Quimby : ** I fully agree with the writer of 
the paper. The subject of appendicitis is one of great 
importance because the last few years there seems to be 
a disposition amongst the younger members of the pro- 
fession, especially the surgical fraternity, to operate on 
almost every case. In fact the knife seems to have been 
substituted for therapeutics altogether. Now, I have 
records of some twenty or thirty cases which I will not 


take time to narrate, but while I am fond of operating, 
yet I really think the physician should be the one to first 
take charge of these cases, and it is upon him that the suc- 
cess or non-success of treatment often depends. I will re- 
late one case typical of many. Three or four months ago I 
was called by a physician to operate for appendicitis. There 
was some doubt in his mind, however, whether there was 
appendicitis, for although the patient had severe pain in 
the region of the appendix, yet we know that pain in that 
region may be due to a variety of causes — perityphilitis, 
etc. I have known several patients to be operated upon 
and life put in jeopardy when it was not necessary. The 
first thing which the physician did in this case was to put 
the patient under an anodyne and keep him under it. 
Now, that anodyne would make an operation for appen- 
dicitis necessary. Instead of doing that; the physician 
should have cleared out the bowel thoroughly. As 
the writer of the paper has truthfully said, a great many 
of these cases are accompanied by constipation. The 
first thing, then, for the physician to do is to thoroughly 
free the bowel. Not by an enema. I differ from the 
writer in that respect. My rule always has been to give 
five or ten grains of calomel and some saline. A little 
antimony helps very much. Then add thorough poultic- 
ing outside. I have not poulticed as much inside as Dr. 
Baldwin has, although I can see good use for it. That 
treatment having been carried out, in only one of the 
thirty cases which I saw was there necessity for operation, 
and in that instance the abscess had proceeded so far that 
surgery was required. But there is a disposition to sub- 
stitute the knife for therapeutics, which I think is a great 

*' One other case, that of a lady who had had a number of 
attacks^ had been seen by a celebrated physician in New 


York who thought that there was nothing to do but to re- 
move the appendix. The patient came into my care. I 
found that she was a believer in thorough dressing with- 
out regard to pressure on the intestinal tract. This was 
three years ago, and by changing her mode of dressing 
and moving the bowels properly she has not had an 
attack since. I believe it had all been due to restriction 
of the abdominal wall by faulty dress.'* 

Dr. M. Lampson : ** The paper has touched upon one 
of the most important matters, probably, which could 
come before the surgeon. The burning question at the 
present time seems to be« when shall we operate in ap- 
pendicitis? Or shall we operate at all? It is a question 
which is likely to come to any physician at any hour. It 
is a very troublesome one. On the one hand we have 
surgeons who teach us that we should in all cases, with- 
out exception, as soon as there is any suspicion connected 
with the appendix, take it out. That seems to be the 
radical view of the appendix from the side of the opera- 
tor. On the other hand we have the position assumed 
by the conservative physician who is slow to operate if to 
operate at all. Of course he claims, and very rationally, 
that forty per cent, of his cases, some say ninety percent., 
are sure to get well without any interference whatever. 
Now, that carries the point down to this : H ow many people 
are going to be sacrificed by the previous operator? The 
operator who is so anxious to record the number of his 
operations. There is no doubt in my mind, from what I 
can gather, that a great many lives are being sacrificed 
to the radical view of those who would operate in all cases 
as soon as the diagnosis is at all clear. 

" My own experience in these cases has been rather 
unfortunate. Of the operative cases which I have had 
the last year, four in number, three have died. That 


would rather discourage most operators. But I think 
the point is not by any means settled. I am trying to 
get more light, for with all the light shed on the 
subject the past few years we do not see very clearly. 
We are groping in the dark. Perhaps some genius will 
tell us just what to do, and when to do it. We are wait- 
ing for some Moses to lead us out of the wilderness.** 

Dr. P. A. Harris: "It seems to me that those of 
us who began to practice about twenty or twenty-five 
years ago have been led astray. Now the surgeon, when 
he begins to talk about appendicitis, and whether it is a 
proper case for him to operate upon, tells us that we 
have done wrong if we have placed the patient under the 
influence of opium before his arrival. When he arrives, 
he stops the opium, which formerly was the basis of a 
treatment which gave very good results, because he wants 
to find out whether it is a proper case to operate upon or 
not. I often yield in consultation and operate for 
appendicitis when I would rather place the patient under 
the influence of opium — opium as prescribed by Dr. 
Alonzo Clark, under whom many of us studied years ago 
and for whom we had the highest respect. He would 
tell us that if we gave cathartic medicines and tried to 
make the bowels move in that manner, we would probably 
lose four cases out of five. But if we w6uld saturate the 
patient with opium and bring the respiration down to 
thirteen or fourteen a minute and keep them there,, 
and ignore the necessity for the bowels to move for 
several days — a week to nine days — the patient would 
generally get well. In those days we did not meet with 
the embarrassments which we encounter now, and we are 
forced to consider whether the frequent resort to oper- 
ative treatment in appendicitis is not a step backward. 

" The statement is usually made to us by the surgeon, 


that he finds evidences of such a pathological condition 
as indicates operation. But my friend on the right, and 
many of you, tell me that these abscesses take care of 
themselves ; that they have two or three ways of opening 
— into the bowel, into the cavity of the peritoneum, 
sometimes externally. They say that if you lock the 
bowel and prevent peristaltic action of the intestine, you 
will limit the inflammation and bring about resolution, or, 
if perforation takes place, it will be into the bowel and 
the patient will recover. Practically, that is what hap- 
pens in a good many cases. If the abscess breaks into 
the cavity of the peritoneum, which only rarely occurs 
when the patient is put under the influence of opium, 
we know the result — the patient is lost. 

" I am not willing to say that 1 stand against operation, 
but I think there are many gentlemen in this room who 
are seriously considering whether they ought not to stand 
up for the opium treatment. When called to the case 
early, either place the patient under the influence of 
opium at once and keep him under it, or else operate at 
once. If you are going to withhold opium, I think it is 
better to operate." 

Dr. Richard C. Newton: **I can hardly accept the 
statement of one gentleman, that a surgeon of New 
York advises an operation in every case. In fact, I 
know that the gentleman does nothing of the sort. He 
insists on operating, if possible, between the attacks. 
He recognizes, with Dr. Balleray, that certain cases give 
pretty sure indications how the particular attack will 
terminate, and always, when he thinks it safe, he allows 
the acute attack to subside. He does not operate indis- 

Dr. A. W. Sullivan : " I am glad one phase of the 
subject has been brought out, namely, that there are two 


ways of improving this very serious disease — appendi- 
citis. I am glad that there are two ways of treating it. 
Those who are surgeons will take the knife ; those of us 
who are in the country will take the mush treatment. I 
believe, with the gentleman on my left, in putting off 
operation. I would like to ask those who perform opera- 
tions whether they take into consideration in their per- 
centage of cures, the cases in which they find no appendi- 
citis after making the incision? Certainly, in those cases 
there would have been recovery. But do they not say, 
* Operated for appendicitis ; recovery ?' I do not believe 
that if such cases were excluded, and also cases of typhil- 
itis, etc., there would be more than forty per cent, of 
cures of real appendicitis from operation. Perhaps many 
of that class were cured with the mush bistoury.** 

Dr. J. M. Barton, of Philadelphia: **! would answer 
the question put by the gentleman, by saying that I have 
been present, as operator or in other capacity, at a num- 
ber of appendicitis operations, and have never yet found 
the appendix not inflamed. When the operation for 
appendicitis first came before us, I was very conservative 
in the matter and hesitated considerably about operating. 
But the more I see of appendicitis the more I operate, and 
the earlier I operate. I have never yet been sorry that I 
operated, but in several instances have been sorry that I 
did not open the abdomen. In one case the patient 
would in all probability have recovered under operation, 
for there was every reason to think that a small quantity 
of pus had formed and had encysted, and the subsequent 
history of the case showed this to be a fact. The 
patient's condition had improved ; he was up and about 
some weeks later when the abscess ruptured, peritonitis 
developed and caused death. Quite recently — inside of 
a week — a colleague of mine was retaining a patient in 


the hospital ward with the expectation of operating 
between attacks, when suddenly a small abscess ruptured 
and general peritonitis resulted. Therefore, the more I 
see of appendicitis, the more I am in favor of operating, 
and operating early. In the first place, what is the mor- 
tality from operation for removal of the appendix when 
there is no appendicitis and no peritonitis? In operating 
between attacks, when no inflammation is present to 
complicate matters, statistics would show, and my own 
experience points in the same direction, that the 
recoveries exceed 99 per cent. What is the recovery in 
all cases of appendicitis that are not operated upon? 
By the mush treatment we have a mortality of 10 to 15 
per cent. 

** Concerning the manner in which the appendicitis 
starts, there are two classes of cases, i. The fulminating 
cases, in which there are no adhesions around the appen- 
dix; it ruptures, and frequently ruptures early. I had 
such a case with Dr. S.; seen about the third day; 
operated ; found, as I had expected and for that reason 
had given a doubtful prognosis, general peritonitis, with 
no attempt to wall off by adhesions at all, the appendix 
containing a perforation about the size of a crow's quill. 
It would not have been appropriate to wait until the 
eighth or ninth day in that instance. In some cases with 
the intestines lying around the inflamed appendix in a 
more or less accidental manner, adhesions form, shutting 
off an abscess containing from half a teaspoonful to a 
hatfull of pus. Ruptures may take place early — on the 
second or third day, while, on the other hand, I have 
operated on the third week and found the abscess walls 
still intact. The great danger is in peritonitis, and since 
we can not tell beforehand which cases are in danger of 
peritonitis and which ones are not, why not operate first 


as well as last ? If the cases are to be operated upon at 
all, surely there is less danger to operate early than to 
operate late. 

" The question is, what cases will do badly ? What 
ones require operation ? Today, I do not think we know. 
What I think would be advisable is that doctors, when 
they have cases, should keep a full record of them, 
relating to the temperature, etc., and a special effort 
should be made to secure bacteriological examination. 
Morris speaks of a low temperature as being a dangerous 
sign, as occurring in cases in which adhesions are less 
likely to be present. If we can tell what cases will ulti- 
mately require operation, it is better to operate upon 
them at once. Richardson says that if a foecal sound is 
heard on listening to the intestine, general peritonitis 
does not exist. What we want to know is what cases are 
likely to recover. We can not depend on the tempera- 
ture at all. I have recently seen a case in which there 
was at least a pint of pus, and the temperature was 99^ F. 
Speaking of the second class of cases, in which the reader 
said wait until the eight or ninth day, I had such a case 
here in Atlantic City about a month ago ; adhesions were 
numerous, yet rupture had occurred on the third day, 
and general peritonitis resulted.*' 

Dr. E. Ill : ** It seems to me that exclusive views on 
the one or the other side of this question must be 
erroneous. Ever since we began to operate for appendi- 
citis I have held that a certain number of cases get well 
and remain well permanently without any operation. 
That view I still hold. The temperature has been 
spoken of several times today. Now, the temperature 
must be taken, not by the mouth nor by the axilla, but 
by the rectum. A low temperature by the mouth may 
be present when that in the rectum is 104^ or 105*^ F. 


Xhat is one of the most important points in all abdomi- 
nal inflammation. It is so important that I have been 
misled again and again on the first aspect of the case, by 
being told that the temperature was very low. perhaps 
99.5^ or 97^ F. But, on taking the temperature by the 
bowel, it was 104° or 105*^. 

** In considering an operation, it is not only the 
temperature which is to be considered, but also the 
general condition of the patient, the pulse, the size and 
consistence of the tumor. I do not think that I operate 
upon one out of six or seven cases which I see. 

" I am very sorry my friend Dr. Harris has spoken for 
the old opium treatment. I do not know of anything 
which is so misleading, of anything which covers up 
symptoms so thoroughly as does opium and antipyretics. 
It is like the ostrich, which hides its head in the sand 
when he sees an enemy. If a physician wants to have 
comfortable nights, to sleep well, to drive about with 
ease and think his patient is in good shape, all he has to 
do is to give him opium. But the trouble will come as 
a clap of thunder and his patient will die when he least 
expects it.*' 

Dr. Reily : " I think we owe a debt to Dr. Balleray for 
the clear cut, precise statement of this question in so 
short a paper. However, there can be, in my opinion, no 
definite rule laid down as to what cases to operate upon 
and what ones not to operate upon. I remember the 
case of a neighbor who went to Dr. Janeway and had the 
diagnosis of chronic recurring appendicitis confirmed, but 
an operation was advised against. Dr. Fowler, of 
Brooklyn, was seen, who confirmed the diagnosis and 
eidvised operation. But no operation was performed, and 
three days later the man had an attack and died. 

** There is one class of cases of recurring appendicitis 

MINUTES. . 57 

which require operation, less on account of danger to life 
than to relieve suffering. I had such a case under obser- 
vation three months, six weeks of which were spent in 
the hospital. There was no immediate danger; no oper- 
ation was done until the end of the third month ; the 
pain continuing, the appendix was removed, and was 
found to be the seat only of endo-appendicitis. He has 
worked every day since — nearly a year. 

" About two months ago a patient had all the symp- 
toms of appendicitis. He, however, survived, went to 
work after about three weeks, and continued to work 
about a month. But he suffered pain constantly, with- 
out temperature, and decided to have the appendix 
removed. I believe that in that class of cases one is 
justified in operating, although there is no danger from 
abscess. ^ 

**The older members of this Society remember that it 
was a constant occurrence in their practice to meet with 
cases of peritonitis. It was a part of their routine work 
to treat such cases. It must have been due usually to 
disease in the tubes in the female sex, or in the appendix 
in males. The gynecologist has snatched from the 
female her peritonitis by his operation, and I believe the 
surgeon has largely saved the cases of appendicitis by hi$ 
early operations. If I had appendicitis today I would 
call the surgeon in whom I had confidence and have my 
appendix removed. I do not believe there is a man who 
can safely and truly say that any case of appendicitis is 
sure to get well. I^do not believe there is a surgeon or 
a physician who has a case of appendicitis who is not 
uneasy until that case gets better, , realizing that at all 
times there is danger. I would operate, and operate 

Dr. Boardman Reed : " It makes all the difference in the 


world whether we recognize appendicitis early or late, 
and also whether one is in the city or in the country. Now, 
I had an experience during a long period, at least twenty 
years, in treating these cases, and can recall typhlitis, 
perityphlitis and peritonitis along down to the point 
where today we recognize all of them as probably appen- 
dicitis. My treatment in the beginning was opium, rest 
and poultices. I lost about half to three-fourths of my 
cases. Then I went to the opposite extreme and favored 
operation in all cases. I believe now that I have a 
medium which is more nearly the correct ground. If 
one is called to a case at the very commencement, gives 
calomel and salines, the chances are three to four, if not 
four to five, that the patient will get well. When the 
case has gone beyond that point and an abscess has 
formed, now that we have a hospital and expect surgeons 
to come and operate, I favor operation. In the country, 
away from surgeons, hospitals and trained nurses, I 
should agree with Dr. Harris in ordering rest in bed, 
opium and poultices." 

Dr. Riggs : " It has fallen to me to treat a number of 
cases of appendicitis with purgatives, and I have, I think, 
saved the lives of a number of people in that way. But 
when the purgative does not give relief, and a circum- 
scribed tumor is forming, I certainly would recommend 
operation. There may be a foreign body or concretion 
in the appendix, which, when the bowel is distended with 
gases, can not be recognized through the abdominal 
parietes, but which may cut off the drainage of the 
appendix, give rise to local infection, or infection of the 
general peritoneum. To give opium, locks up the 
secretions and does more mischief than good. After 
you have opened the bowel and the soreness disappears, 
you can feel that the disease is on the decline." 


Dr. Balleray: "If one wishes to be misunderstood let 
him read a paper. It seems that I have been misunder- 
stood to say that in the fulminating form of appendicitis 
I would wait until the sixth or ninth day before operat- 
ing. It is just that class of cases which one should 
operate upon immediately. The objection raised to 
giving opium was to determine what form of appendicitis 
one had to deal with. In other cases of slow develop- 
ment, seen the third or fourth day, I think it is better to 
wait until the abscess is walled off thoroughly, for I 
have seen patients die in the hands of the surgeon, due, 
I think, to the fact that the barriers were not sufficiently 
firm, but broke down, and the general cavity became in- 

*' With regard to cases of interstitial or catarrhal 
appendicitis, with a certain amount of fibrous exudation 
upon the intestine and appendix, I believe those are 
cases which should be let alone. They are cases which 
later may give rise to recurrent attacks and require 
operation. They are not attended with violent symptoms. 
The pulse is not exceedingly rapid, the countenance is 
good. Tumefaction may be present, due to plastic 
lymph, which will often be absorbed. In this class of 
cases I think an operation is unjustifiable, but if there is 
a recurrent attack the question of operation arises. 

** As to treatment by mush, I have had no experience 
with it, but I believe any bland article of food is in order. 
Whether to poultice the patient outside or inside is a 
question to determine for yourself. But there is one 
treatment which ought to be frowned down. That is the 
treatment by opium. We have been told that Dr. Clark 
treated peritonitis with opium. But in Dr. Clark*s day 
nothing was known about appendicitis. I do not believe 
that appendicitis was ever cured by opium. When 


germs are swarming in the appendix, the seat of inflamma- 
tion, I do not believe that opium does good. I believe, 
however, that a certain amount of opium may be good 
where it is decided not to operate, or to wait a time. 

" Another remark made by Dr. Harris, it seems to me,, 
should be corrected. He says it is rare for an abscess 
resulting from appendicitis to burst into the peritoneal 
cavity. My experience is the reverse, that the peritcmeal 
cavity is the most common place for the abscess to 
burst into. The patient should not be allowed to run 
the risk of such a termination. For that reason I stated 
that where the symptoms are acute, high temperature^ 
high pulse rate, symptoms pointing to suppurative pro- 
cess going on rapidly, the operator should not delay 
beyond the fifth day. If the symptoms are not acute, 
but tumefaction is increasing, he should operate at lea>t 
as early as the ninth day." 

Dr. P. A. Harris: **I rise to a question of privilege. I 
thought I stated that there were three ways for the 
abscess to burst — into the bowel, more rarely into the 
peritoneal cavity, and rarely externally." 

Delegates from the New Jersey Pharmaceutical Associ- 
ation presented their credentials, with report. 

Dr. Morrill, delegate from the New York State Medical 
Society, presented his credentials, and in the course of a 
few remarks of kind greeting, said the Medical Society 
of the State of New York always stood ready to cooper- 
ate with the Medical Society of New Jersey in any pro- 
ject which would tend to elevate the standard of the 
profession and benefit mankind. 

The President extended a hearty welcome to all visit- 
ing delegates, and expressed the hope that they would 
share the work and pleasure of the occasion. 

The Third Vice-President, Dr. Luther M. Halsey, read 


an essay, " Headaches, Auto-intoxication a Factor." On 
motion, it was received and referred to the Committee on 
Publication. On motion of Dr. Pierson, the further read- 
ing of papers was discontinued until after the transaction 
of business of the Society. Papers on the program not 
read in full should be read by title. Carried. 

Report of the Committee on Fellows* Prize Essay : 

Atlantic City, June 23. 1897. 

The Committee on Fellows' Prize Essay would respectfully report 
that two essays have been received, and the Committee have unani- 
mously awarded the prize to the essay whose author's nom de plume 
is •• Globus Ocule," with the motto, " Between the dark and the day- 
light," with honorable mention; also of the essay whose author's 
nom de plume is ** Henry Esmond," and his motto, '* She stoops to 

The writer of the prize essay is Dr. George Bayles, of Orange, N. J., 

who is thereby entitled to the Fellows' Prize of $100. The writer of 

the essay awarded *' honorable mention " is Dr. Floy Mc Ewen, of 

Newark, N. J. 

Wm. Elmer, 

Chas. J. Kipp, 

Philander A. Harris, 


On motion, the report was accepted. 

Dr. William Elmer moved that the Treasurer be 
authorized to pay the amount of the prize and that an 
assessment be made upon the Fellows, pro rata, to meet 
the disbursement. Carried. 

Dr. Walter B. Johnson read the report of the Nomina- 
ing Committee, as follows : 

Meeting of the Nominating Committee held June 22, 1897. The 
following members were present or not present or represented, as 
noted : 

Atlantic, E. A. Reiley*; Bergen, D. A.Currie; Burlington, E. Hollings- 
head; Camden, M. West; Cape May, Eugene Way; Cumberland, S, 
T. Day ; Essex, W. J. Chandler ; Gloucester, Geo. E. Reading ; 


Hudson, T. R. Chambers; Hunterdon, E. H. Moore; Mercer, T. 
H. McKenzie*; Middlesex, H. R. Baldwin; Monmouth, Henry 
Mitchell ; Morris, Cuthbert Wigg ; Passaic, W. B. Johnson ; Salem, 
D. Garrison*; Somerset, A. L. Stillwell ; Union, B. Van D. Hedges ; 
Warren, C. B. Smith. 

Nominations were made for the various offices and committees and 
are herewith presented : 

President — David C. English. 

First Vice-President — ^C. R. P. Fisher. 

Second " — Luther M. Halsey. 

Third " —John J. H. Love. 

Corresponding Secretary — E. L. B. Godfrey. 

Recording Secretary — Wm. Pierson. 

Treasurer — Archibald Mercer. 

Standing Committee — Stephen Pierson, Wm. D. Iszard. 

Place of next meeting, Asbury Park, June 28, 29 and 30, 1898. 

Committee of Arrangements — Henry Mitchell, S. Johnson, D. 
McLane Forman, Danl. A. Currie, Geo. £. Reading. 

Business Committee — Walter B. Johnson, Geo. Van Wagencn, E. 
Hollingshead, W. Updyke Selover, T. R. Chambers. 

Prize Essay Committee — Philander A. Harris. 

Delegates to American Medical Association — H. Genet Taylor, 
Hardy M. Banks, B. D. Evans, Wm. H. Shtpps, N. M. Stokes. 

Delegates to Massachusetts State Medical Society — T. R. Chambers, 
J. P. Hecht. 

Delegates to Rhode Island State Medical Society — W. B. Mathew- 
son, T. H. Tomlinson. 

Delegates to Connecticut State Medical Society — ^J. A. Exton, Jno. 
L. Leal. 

Delegates to New Hampshire State Medical Society — ^James Hunter, 
Philander A. Harris. 

Delegates to Pennsylvania State Medical Society — Geo. E. Ridding, 
Alex. Small. 

Delegates to New York State Medical Association — R. C. Newton, 
D. A. Currie, E. B. Silvers, Walter B. Johnson, P. A. Harris. 

Delegates to Maryland State Medical Society — S. T. Day, W. P. 

'Not present. 


Delegates to American Pharmaceutical Association — H. M. Coit» 
W. B. Macfarland. 

Delegates to Mississippi Valley Medical Society — O. B. Gross, 
£. HoUingshead. 

The above is respectfully submitted. 




On motion, the Secretary of the Society was instructed 
to cast the ballot of the Society for the ticket nominated, 
and Dr. Pierson cast an affirmative ballot. 

The President announced that he had received a com- 
munication from the President of the Executive Com- 
mittee of the British Medical Association, asking the 
Society to send a delegate to the Association. 

On motion, the communication was received and the 
President was empowed to appoint a delegate, and later 
he appointed Dr. William Pierson. 

Dr. J. W. Stickler read in abstract a paper, " Scarlet 
Fever Reproduced by Inoculation, and Some Important 
Facts Deduced Therefrom.** On motion, it was received 
and referred to the Committee on Publication. 

Dr. Alexander McAlister read a paper, *' The Present 
Status of the Serum Treatment of Diptheria.*' On 
motion, the author was extended a vote of thanks for his 
valuable summary, and a copy was requested for publi- 

Dr. William Edgar Darnell read a paper, "Four Types 
of Infantile Diarrhoea and Indications for Treatment.*^ 
On motion, it was received and referred to the Committee 
on Publication. 

The President called attention to the communication 
which had been read regarding the Rush Monument 


Dr. William Elmer said that no one who had been 
present at the recent meeting of the American 
Association and listened to the earnest statement of the 
case by Dr. Guihon, could fail to have been impressed 
with the urgent need of completing this fund and erect- 
ing a monument to Dr. Rush in Washington, which 
would be an honor to the medical profession of America. 
On that occasion the several States of the Union had 
agreed to raise varying proportions of the sum required, 
and New Jersey through the Corresponding Secretary 
of her State Medical Society, promised to do what was 
in her power. 

Dr. Elmer then moved that a committee of five be 
appointed in the matter of the Rush Monument Fund, 
with power to act in their discretion. Carried. The 
President appointed Drs. William Elmer, Chairman ; 
E. L. B. Godfrey, W. J. Chandler, Reading and Day. 

Dr. D. C. English moved that the communication from 
Dr. Sternberg, relating to the bill before Congress on 
anti-vivisection in the District of Columbia, be referred 
to the Standing Committee, with power to act. 

He accepted the interpretation put upon the words 
** power to act," by Drs. Skinner and Shepherd, to com- 
municate with the senators and representatives from this 
State, requesting them to oppose the bill. The motion 
was adopted. 

The President appointed Drs. H. M. Weeks and J. C. 
Applegate Essayists for next meeting of the Society. 

Amendment to the By-Laws, Chap, i. Sec. 4 ; 

Insert before the first paragraph : After the death of a Permanent 
Delegate, the Secretary of the District Society of which the Perma- 
nent Delegate was a member, shall send proper notice of such death 
to the Corresponding Secretary of the Medical Society of New Jersey. 


Insert in the last paragraph of the same Section, after the words 
*' shall be reported," the words, '*as soon as possible'* 

Insert in the next to the last line of the same paragraph, the word 
^'then," after the words " District Societies may." 


Resolved^ That the thanks of this Society be and are tendered to the 
Committee of Arrangements, for their very efficient efforts to make 
this meeting a successful one; also to the proprietor of the United 
States Hotel and all others who have ministered to our comfort and 

Circular letters of interest to the members of this 
Society were received and distributed by the Secretary. 

The Standing Committee was made the Publishing 
Committee, with the usual powers. 

The Society adjourned, to meet the fourth Tuesday 
in June, at Asbury Park, 1898. 


Recording Secretary. 


It is with the deepest sorrow I announce to the members of the 
Medical Society of New Jersey, the death of our Third Vice- 


which occurred very suddenly at Montclair, on the morning of July 
30, 1897 ; and I hereby appoint the following Committee, with the 
President, to represent the Society at the funeral service on Monday, 
August 2d : Drs. William Pierson, C. J. Kipp, L. M. Halsey, £. L. B. 
Godfrey, Archibald Mercer, William Elmer, Henry Mitchell, John D. 
McGilli P. C. Barker, C. R. P. Fisher, P. A. Harris, Charles Young, 
G. H. Balleray, T. R. Chambers. 



' New Brunswick, N. J., July 31, 1897. 

In accordance with the requirement of the By-Laws of the Medical 
Society of New Jersey, Chapter II., Section 2, I hereby appoint 


of Orange, Third Vice-President of the Society, to fill the vacancy 
occasioned by the death of Dr. John J. H. Love. 

I also hereby appoint 


of South Orange, Recording Secretary of the Society, in place of Dr. 
William Pierson, resigned. 


New Brunswick, N. J., August 12, 1897. 



Report of the Corresponding Secretary. 

, Camden, N. J., June 22, 1897. 

To the Medical Society of New Jersey : 

The Corresponding Secretary respectfully reports that he has 
attended to the duties that have devolved upon him, during the past 
year. The Transactions of this Society have been forwarded to the 
Secretaries of the various State Medical Societies, to the Honorary 
Members of this Society, to the State Library, the New Jersey 
Historical Society, the libraries of Princeton University and Rutgers 
College, the American Medical Association, the New York Academy 
of Medicine, the College of Physicians and Surgeons of Philadelphia, 
the Boston Medical Library, the library of the Surgeon General's 
office, U. S. A., the library of the Camden City Medical Society, and 
to the various hospitals throughout the State. In return, the Trans- 
actions of the Medical Societies of Alabama, Colorado, Connecticut, 
Indiana, Iowa, Kentucky, Maine, New Hampshire, New York, RJiode 
Island, Texas, Vermont, Wisconsin, and the College of Physicians 
and Surgeons of Philadelphia, and reports of the Boards of Health 
of Connecticut. Michigan, New Jersey and Pennsylvania, have been 
received. These transactions and reports have been forwarded to 
Dr. William Elmer, of Trenton, for deposit in the State Library at 

In accordance with the resolution relating to the Bacteriological 
Laboratory at Princeton, introduced by Dr. E. Hollingshead of Pem- 
berton, and adopted at the last meeting of this Society, and with the 
instructions to refer the matter to the District Societies, adopted at 
the same time upon a motion of Dr. W. H. Parry, of Mt. Holly, a 
circular letter, under date of January 8th, was forwarded to the 


officers of this Society, to President Patton. of Princeton, and to 
th« Secretaries of the District Societies, urging the members of this 
Society to exert their influence with the members of the legislature to 
secure an appropriation from the legislature for the maintenance ot 
the Laborator>'. 

Prompt acknowledgments were received from the Secretaries of the 
District Societies of Atlantic. Cumberland, Gloucester, Hunterdon. 
Mercer, Middlesex, Monmouth, Morris, Passaic. Somerset. Sussex, 
Warren and Union, expressing the interest of their members in this 
matter. No responses were received from the Counties of Bergen, 
Burlington. Camden, Cape May. Essex. Hudson. Ocean and Salem. 
A'n appropriation of $3,000 was secured from the legislature and has 
been placed at the disposal of the State Board of Health. 

At the last meeting of this Society. I had the honor to submit a 
communication from Surgeon-General George M. Sternberg. U. S. A., 
suggesting that this Society take action against a bill, pending in 
Congress, restricting the practice of vivisection for scientific purposes, 
in the District of Columbia. This communication was referred to a 
special committee, consisting of Doctors Daniel Strock, D. C. 
English and Charles Young, who presented resolutions, afterwards 
adopted, to the effect that this Society respectfully request the mem- 
bers of Congress from New Jersey to use every proper effort to 
prevent the bill in question from becoming a legal enactment, and 
that printed copies of these resolutions be forwarded to the New 
Jersey representatives in Congress, and to the Chairman of the Com- 
mittee on District of Columbia in the Senate and House of Rep- 

In compliance with these instructions, a circular letter, under date 
of January 14. was sent to the members of Congress above named, 
and to the Surgeon-General of the United States Army, Navy and 
Marine Hospital Service. Responses were received from a majority 
of these gentlemen, expressing their willingness to comply with the 
wishes of this Society. This bill, which is now pending in the 
Senate, has been favorably reported by the Committee on the District 
of Columbia and placed on the Senate calendar, and Surgeon- 
General Sternberg, under date of June 9. writes : 

** It ifi important that members of the Senate should be urged to 
oppose the legislation asked for, and whatever action your Associa- 
tion takes U> aid in this will be very useful at the present time." 


In compliance with Section 4, Chapter II., of the By-Laws of this 
Society, a circular letter, under date of May ist, was sent to the 
Secretaries of the various District Societies, requesting them to for- 
ward the names and addresses of their Permanent Delegates, and the 
' number of additional Permanent Delegates to which their Societies 
are entitled, either by increase of membership, forieiture of member- 
ship, or death. Replies were received from the Secretaries of the 
Counties of Atlantic, Cape May, Cumberland, Essex, Gloucester, 
Hudson, Hunterdon, Mercer, Middlesex, Morris, Monmouth. Passaic, 
Somerset, Sussex, Warren and Union, making in all sixteen counties. 
The Secretaries of five of the District Societies did not respond. 
From the list of Permanent Delegates, published in the Transactions, 
and from the data given, I have compiled, and present herewith, a 
list of the Permanent Delegates of this Society, with addresses and 
date of election. The absence of complete data may render this 
list partially incomplete. • 

Bergen — H. C. Neer, 1892, Park Ridge. 

Burlington — J. Howard Pugh, 1892, Burlington; N. Newlin 
Stokes, 1895, Moorestown. 

Camden — Alexander Marcy, Sr., 1892, Camden; James M. Ridge, 
1892, Camden ; O. B. Gross, 1895, Camden ; Duncan W. Blake, 1895, 
Gloucester City; William H. Ireland, 1895, Camden. 

Cape May — Virgil M. D. Marcy, 1892, Cape May City. 

Cumberland— \^ , H. C. Smith, 1892, Millville. 

Essex — Charles Young, 1892, Newark; John J. H. Love, 1892, 
Montclair; Joseph C. Young, 1892, Newark; Arthur Ward, 1892, 
Newark; George R. Kent. 1896, Newark; William J. Chandler, 1896, 
South Orange; Edward J. Ill, 1896, Newark; Daniel M. Skinner, 
1896, Belleville; George Bayles, 1896, Orange; Herman 'C. Bleyle, 
1896, Newark. 

Gloucester — George Evans Reading, 1893, Woodbury; George C. 
Laws, 1895, Paulsboro. 

Hudson — John D. McGill, 1892, Jersey City ; Robert F. Chabert, 
1892, Hoboken. 

Hunterdon^lsa^c S. Cramer, 1892, Flemington; William S. 
Creveling, 1896, Valley. 

Mercer — Cornelius Shepard, 1892, Trenton; H. M. Weeks, 1895, 
Trenton; R. R. Rogers, Sr., 1895, Trenton; David Warman, 1897, 


Middlesex -Q, H. Andrus, 1892, Metuchen; John Helm, 1895, 
New Brunswick. 

Monmouth — Henry Mitchell, 1892, Asbury Park; Henry G. 
Cooke, 1892, Holmdel. 

Morris— \, W. Condict. 1892, Dover; John S. Stiger, 1892, 
Mendham ; Levi Farrov^r, 1895, Middle Valley. 

Passaic — William B. Johnson. 1892, Paterson; P. A. Harris, .1893, 
Paterson; George H. Balleray, 1896, Paterson. 

Salem — B. A. Waddington, 1893, Salem. 

Somersel'-H, G. Wagoner, 1892, Somerville'; S. O. B. Taylor, 
1897, Millstone. 

5«j^^;ir— Sidney B. Straley, 1892, Andover; E. Morrison, 1895, 

Union— Alonzo Pettit, 1893, Elizabeth; E. B. Silvers, 1893, 
Rahway; J. A. Coles, 1896, Scotch Plains; T. H. Tomlinson, 1896, 

IVarren- John H. Griffith, 1892, Phillipsburg ; William H. 
McGee, 1896, Belvidere. 

Respectfully submitted, 

E. L. B. GODFREY, M.D., 

Corresponding Secretary, 


Treasurer's Report. 


Dr. Archibald Mercer, Treasurer^ in account with the Medica 
Society of New Jersey : 

June, 1897. Dr, 
Atlantic County Assessment $24 00 

Bergen " 

Burlington " 

Camden " 
Cape May 

Essex '* 

Gloucester " 



26 00 

28 CO 
51 00 
17 00 
35 00 
183 00 
22 00 



Hudson County Assessment $61 00 


(< t< 


<< (( 


<t (( 


(< (t 


<( (( 


<« It 


t« (< 


<< <( 


(4 ' «( 


« ' (t 


(i <( 

18 00 
56 00 

22 00 
38 00 

45 00 
70 00 

14 00 

20 00 

20 00 

53 00 
20 00 

$823 00 

J nterest on U. S. Bonds 102 00 

Dec. 18, 1897. Loan Howard Savings Institution 850 00 

To Cash in hand June, 1896 429 18 

To U. S. Registered Bonds 2,250 00 

14*454 iS 

1896. Cr. 

June. By paid Wm. Pierson, Recording Secretary, $14 50 

H,. W. Elmer, Standing Committee. 19 50 

E. L. B. Godfrey, Corres. Sec'y. . . 21 84 

A. Mercer, Treasurer 8 06 

M. W. & C. Pennypacker 19 00 

H. C. Coit, Chairman of Com. ..... 13 65 

R. C. Shultz, Stenographer 50 00 

L. J. Hardham, Transactions 300 00 

863 75 



Aug. 17. 
Sep. 24. 
Dec. 18. 


May 4. By paid Wm. Pierson 11 90 

$1,322 20 

By Cash balance in Bank, June, 1897 881 98 

By U. S. Bonds. 2,250 00 

$4,454 18 
Respectfully submitted, 





Report of the Delegate to the New Hampshire 

State Medical Society. 

June 22, 1897. 
To the Medical Society of New Jersey: 

Your delegate appointed to attend the one hundred and sixth anni- 
versary meeting of the New Hampshire Medical Society, did so at 
Concord (Pilgrim Hall), May 24th and 25th. He was warmly received 
by the President, Abel P. Richardson, M.D., their Secretary, Gran- 
ville P. Conn, M.D., and the other officials of this thrifty society. AH 
of their papers were not only interesting, but exhaustive. I was par- 
ticularly interested in the essay on ** Phlebotomy," by James A. Leet^ 
M.D., Enfield. An earnest discussion followed. This is a subject 
rarely touched upon in these modern times, the judicious practice of 
which many are inclined to follow. Your delegate is in warm sympa- 
thy in the value of the occasional use of the lancet, and believes with 
Professor Delafield " that much immediate good results from the wise 
use of the lancet." 

The paper by the Hon. W. L. Foster, of Concord, on " Medical 
Expert Testimony," was immensely interesting and complete. ** The 
Scientific Description of the X-Ray, with a Practicable Exhibition of 
Its Application to Surgery," by Professor J. Milnor Coit, Ph.D., of 
St. Paul's School, and Dr. Adrian H. Hoyt, general manager of the 
Whitney Electrical Instrument Company, Penacook, was most thor- 
oughly demonstrative, and the best that i have ever seen, either at home 
or when visiting other State societies where exhibits of this kind, now 
so usual, have been a part of the entertainment. 

The anniversary dinner was largely attended, the Governor of the 
State being an honored guest. It fell to my pleasing lot to be placed 
in close proximity to him. I found him very enthusiastic in his admi- 
ration of his State Medical Society, his after-dinner talk showing his 
desire to further any legislation to add to the success of legitimate 
practitioners. I suppose, aside from their known hospitality, a dele- 
gate from our honored Society being of so rare an occurrence, they 
evidently wished, in their cordial reception of myself, to encourage 
more frequent repetitions. 

Respectfully submitted, 

Rahway, N. J. E. B. SILVERS, M.D. 



Paper Read by Dr. G. H. Balleray, in Opening the 
Discussion on " In the Treatment of Ap- 
pendicitis, IS THE Free Use of the 
Knife Necessary?" 

Mr, President and Gentlemen : 

Some years ago I would have entered upon this discussion with a 
good deal of self-confidence ; today I approach it with a great deal 
of self-mistrust, for I cannot help feeling that the more I see of appen- 
dicitis the less I know about it. I shall endeavor to confine my 
remarks to answering the question propounded by your committee, 
viz.: " In the treatment of appendicitis, is the present free use of the 
knife necessary Y' 

The question cannot be answered off-hand for the reason that every 
case of appendicitis is a law unto itself ; and while in one class of 
cases the free and early use of the knife is absolutely necessary, in the 
other class the use of the knife is unnecessary and therefore unjustifi- 
able. At the outset it is important to bear in mind the different 
varieties of appendicitis actually met with in practice. 

Appendicitis presents itself under five different forms, as follows : 
1st. Acute perforative appendicitis with diffuse general peritonitis. 
2d. Acute simple, catarrhal, or interstitial appendicitis with circum- 
scribed fibrinous peritonitis. 3d, Acute perforative appendicitis with 
localized purulent peritonitis. 4th. Relapsing appendicitis. 5th. Re- 
current appendicitis. Of these the first, third and fourth varieties are 
the most dangerous to life. Recurrent appendicitis is probably the 
chronic form of what was originally an attack of acute, or sub-acute 
appendicitis with circumscribed plastic peritonitis. This at least is 
the conclusion to which I have arrived from the observation of the 
cases occurring in my own practice, as well as those occurring in the 
practice of my hospital colleagues whose operations I have witnessed. 
In most cases of recurrent appendicitis it will be found that the 
original attack was not very severe. It lacked the profound abdom- 
inal shock, pinched countenance, lividity of surface, retracted abdomen 
and early and persistent vomiting of acute perforative appendicitis 
with diffuse general peritonitis ; it also lacked the high temperature and 
frequent, but comparatively full, pulse of aicute perforative appendicitis 


with circumscribed purulent peritonitis. It was, in fact» a moderately 
acute, or sub-acute, appendicitis, catarrhal or interstitial, with localized 
fibrinous peritonitis. 

After the subsidence of the acute symptoms the exudation is gener- 
ally in great measure absorbed, leaving only a small, elongated, indu- 
rated mass in the region of the appendix, which can be easily felt for 
several weeks after the patient is convalescent. 

'The appendix, as a rule, remains adherent to whatever organ or 
structure it was in contact with at the time of the invasion. It is often 
bent upon itself ; its walls are generally thickened and indurated, and 
its cavity is sometimes dilated, sometimes sacculated, and contains a 
thick mucous or caseous looking substance. Stercoral concretions are 
rarely found in the appendix in recurrent appendicitis, whereas I be- 
live that they are almost a sine qua non of relapsing appendicitis. To 
my mind, recurrent appendicitis is the.analogue of catarrhal or inter- 
stitial salpingitis with limited pelvic peritonitis. The pathological 
changes are the same in both ; the symptoms sometimes so closely 
resemble each other that right-sided salpingitis is sometimes mistaken 
for appendicitis and vice versa. But owing to the reflex intestinal 
disturbances, set up by a diseased and adherent appendix, its removal 
may be necessary for pathological changes which would hardly justify 
a resort to salpingotomy. The limits of this discussion will not per- 
mit me to enter in detail upon the pathological changes which occur 
in the various forms of appendkitts. But. as a proper understanding 
of the clinical differences which present themselves to the observation 
of the intelligent practitioner can only be obtained through a clear 
idea of the pathological changes taking place in the appendix and ad- 
jacent structures, I will briefly pass in review the morbid processes 
peculiar to each of the varieties above enumerated. 

Our knowledge of the pathology of appendicitis has been derived 
rather from the observations of practical surgeons in the operating- 
room than of those of pathologists on the post-mortem table. To 
American surgeons is due the credit of having evolved the true 
pathology of the appendix. Their operations, often undertaken within 
a few hours after the manifestation of symptoms, enabled them to 
appreciate the structural changes which characterized the early stages 
of appendicitis ; whereas the older writers could only describe the ad- 
vanced and complicated morbid processes observed after death. 
American physicians have also contributed largely to our knowledge 


of this subject ; and prominent among these is Reginald Fitz, of Bos- 
ton. It must not be forgotten, however, that to M61ier, of France, we 
owe all that we know of the disease under consideration, for it was he 
who first brought order out of chaos and taught that the diseases 
previously described as typhlitis and peri-typhlitis were in reality ap- 
pendicitis, as the morbid process always originated in the appendix. 
Before the publication of M^lier's observations the appendix vermi- 
formis was credited with being an organ of little or no importance, 
the lesions of which often passed unnoticed in the autopsy-room. 
Therefore, all honor to the brilliant Frenchman to whom the medical 
profession and suffering humanity owe a debt of gratitude which can 
never be paid. 

Whatever may be the results of perforative appendicitis, its cause 
is always the same, viz.: The penetration into, and impaction within, 
the cavity of the appendix of a foreign body — generally a stercoral 
concretion. A variety of foreign bodies have been found in the ap- 
pendix ; but all foreign bodies other than stercoral concretions are 
found in only a comparatively small number of cases of perforative 
appendicitis.'. When a hard foreign body, of irregular shape, pene- 
trates into the cavity of the appendix, it produces a condition of irrita- 
bility of the gastro-intestinal tract, which is accompanied by colicky 
abdominal pains, and sometimes vomiting. This condition is exactly 
analogous to that which is produced by the impaction of a gall stone 
in the common bile duct, or of a renal calculus in the ureter. And as 
those conditions are spoken of as biliary and renal colic, so this con- 
dition may properly be called appendicular colic. The signs and 
symptoms which characterize appendicular colic are abdominal pain, 
sometimes vomiting, tenderness over MacBurney's point and rigidity 
of the right rectus abdominis muscle. Under the influence of the 
contractions of the walls of the appendix the foreign body may be 
forced back into the caecum and the symptoms may disappear as 
promptly as those of renal colic after the passage of the obstructing 
calculus into the bladder. But if the concretion remains tightly 
wedged between the opposing walls of the appendix, what happens ? 
Well, two things happen : first, we have an obliteration of the orifice 
of communication between the appendix and the caecum ; second, 
there results a compression of the walls of the appendix and conse-* 
•quently an interference with the circulation in the vessels contained in 
ihose walls. The obliteration of the orifice results in the accumula* 


tion of the products of the glandular secretion of the mucous lining of 
the appendix and distention of its cavity, while front) the compression 
of the vessels results a diminution of the vitality of the organ. But 
the obstruction and compression are not sufficient in themselves to 
accomplish the process of ulceration and perforation. The intervention 
of a third factor is necessary to bring about destruction of the anatomi- 
cal elements of the walls of the appendix. This third factor is found 
in the presence of large numbers of bacteria which invade the 
tissues already weakened and devitalized by the interference with the- 
blood supply, and complete the work of destruction. 

When the process of ulceration and perforation is so rapid that 
nature has no time to throw up protective barriers of lymph around 
the appendix — between it and the general peritoneal cavity — the 
disease presents itself in its most deadly aspect. This variety of 
appendicitis is known as acute perforative appendicitis, and is always 
followed immediately by diffuse general, septic peritonitis. In cases- 
n which the process of ulceration goes on more slowly, and effusion 
of plastic lymph occurs which binds the appendix to contiguous 
structures and thus protects the general peritoneal ca>;ity from the 
sudden extravasation of the contents of the diseased appendix* 
This effusion of lymph is the result of a circumscribed plastic peritonitis. 
As the destructive process in the walls of the appendix, goes on, a 
focus of suppuration develops. The collection of pus surrounds the 
appendix, which occasionally forms a portion of the abscess wall. At 
times, when the abscess is opened, the appendix is found lying 
loose in its cavity, having been entirely separated from the caecum in 
the form of a slough. Cases are occasionally met with in which 
after the existence of well marked evidences of appendicitis the 
symptoms gradually subside, to recur after an indefinite period of time. 
The second or third attack may result in the formation of an abscess 
which contains a stercoral concretion and, occasionally, the debris of 
the sphacelated appendix. These are the cases which I would classify 
under the head of relapsing appendicitis. It would seem probable that 
in these cases the stercoral concretion, which is the real thorn in the 
flesh, excites the morbid process which proceeds to a certain point 
and then becomes quiescent. Later, without any appreciable cause,, 
the fire becomes rekindled and the disease goes on until gangrene and 
destruction of the appendix, and abscess result. In the early stage of 
this class of cases, there has been an effusion of plastic lymph, which; 


^protects the general peritoneal cavity so long as the walls of the 
-abscess do not give way and allow its contents to escape into the 
cavity of the peritoneum. When suppuration occurs the location of 
the abscess will depend upon the position of the appendix at the 
moment of the attack. The normal position of the appendix varies in 
xiififerent individuals. While its upper portion is attached to the pos- 
terior and inner border of the caput coli, its free extremity seems to 
■enjoy a considerable degree of liberty, and consequently, cannot be 
■expected to be found always in the same place. The result of a 
large number of autopsies shows that in a very large proportion of 
cases, the appendix is in contact with the posterior surface of the 
-caecum and the cellular tissue of the iliac fossa. If perforation 
occurs in a case of this sort the resulting abscess will be in the sub- 
peritoneal cellular tissue of the iliac region, and the collection of pus 
most easily reached at the outer mat gin of the caecum. The 
-appendix, if long, may dip down into the pelvis and may be adherent 
to the rectum, or, in the female, to the ovary, fallopin tube, or broad 
ligament. It is sometimes found adherent to several loops of small 
intestine high up in the abdomen. Should perforation and suppura- 
tion occur under such circumstances, the practitioner might easily be 
deceived as to the nature and origin of the resulting abscess. In 
acute catarrhal or interstitial appendicitis, with limited plastic perito- 
' nitis, the changes in the appendix consist in turgescence and thickening 
of its walls, and dilatation of its cavity with a viscid mucous or semi- 
purulent fluid. ,The contiguous coils of intestine are adherent to it 
-and to each other. When of recent date, these adhesions are easily 
broken down with the finger. This form of appendicitis usually 
terminates by resolution — the plastic effusion being gradually ab- 
-sorbed. But if the disease in the walls of the appendix is very exten- 
-sive. subsequent attacks are likely to occur — constituting typical 
* recurrent appendicitis. In acute perforative appendicitis, the process 
of gangrene and ulceration of the appendix may go on so insidiously 
that no marked symptoms occur until perforation has actually taken 
place. This is most likely to occur in cases in which a stercoral 
concretion becomes impacted in the cavity of an appendix previously 
the seat of interstitial inflammation, resulting in a loss of sensibility of 
the organ. 

Symptoms,— ^\v^ symptoms of appendicitis vary with the type of 
the disease. In its most acute form, perforative appendicitis presents 


the following symptoms : Sudden, acute abdominal pain» beginnings 
perhaps in the right iliac fossa, but rapidly spreading over the whole 
abdomen ; the countenance is pinched ; the surface cool and some- 
times livid; the abdomen is retracted, and the right rectus muscle 
rigid. Vomiting is an early and persistent symptom, and is some- 
times accompanied by singultus. The character of the vomiting dif- 
fers from that accompanying the other forms of appendicitis. It is 
more frequent and persistent, and often resembles the vomiting due to 
intestinal obstruction. An obstinate constipation is often present. 
The pulse becomes frequent early in the attack. It may varj' from 
1 20 to 130, 140 or 1 50, and as a rule it is a pulse of low tension. The 
expression of the face, when not altered by the injudicious adminis- 
tration of opium, is indicative of abdominal shock. The facies, 
the pulse and the vomiting are the three symptoms which enable us 
to recognize early this hyper-acute form of perforative appendicitis. 
Tenderness on pressure over MacBurney's point is, as a rule, much 
more marked than at any other point of the abdomen. The tempera- 
ture may not be above normal in the early stage ; at times it is sub- 
normal, but when the peritonitis has become general it may rise to 
102 or 103, although it generally keeps below 102. As the disease 
progresses the abdomen becomes distended,* the vomiting becomes 
almost incessant, the pulse more and more frequent and finally imper- 
ceptible, and the patient sinks and dies from exhaustion and sepsis. - 
Perforative appendicitis with encysted purulent peritonitis. — In 
perforative appendicitis with encysted purulent peritonitis, the pulse may 
reach 1 20 or more at an early stage, and the temperature in the evening 
may exceed 104, especially in young subjects. There maybe vomiting, 
but it is not persistent, and, as a rule, yields readily to intelligent medi- 
cation and alimentation. Constipation, if present, yields to gentle 
laxatives, Or carefully administered enemata. The absence of per- 
sistent vomiting, obstinate constipation, frequent, adynamic pulse and 
pinched, anxious countenance, will serve to distinguish this from the 
hyper-acute form of perforative appendicitis in the early stage. Ten- 
derness over the region of the appendix and rigidity of the right rectus 
muscle, are common to this and the other forms of appendicitis. As 
the disease progresses a well marked tumefaction develops in the neigh- 
borhood of the appendix. This tumefaction is due to the presence of 
'pus, and may continue to increase until -the abscess bursts into the 
peritoneal cavity or elsewhere, unless the surgeon intervenes. 


• Catarrhal^ or- interstitial appendicitis, — In catarrhal, or inter- 
stitial appendicitis, with limited plastic peritonitis, the pulse is never 
very frequent and the temperature rarely goes above 102. The morn- 
ing temperature is generally below 100. The pulse rarely reaches 
110. The expression of the countenance is good. There may be 
tenderness over the appendix, and there generally is more or less 
abdominal pain, but the pain is rarely very severe. Rigidity of the 
right rectus is generally present. After a few days, more or less tume- 
faction in the region of the appendix develops, due to the agglutina- 
tion of coils of small intestine to the appendix by fibrinous exudation. 
Treatment, — The first indication in the treatment of appendicitis is 
rest. The patient should be put in bed and closely watched in order 
to determine early the true nature of the case. No food, except some 
form of animal broth, should be given. Anodynes should not be 
administered, as they tend to mask the symptoms and create some 
doubt in the mind of the practitioner as to the form of disease that he 
is dealing with. It is of vital importance that the type of the disease 
should be recognized at the earliest possible moment, for upon a 
correct appreciation of the nature of the case the success of the 
treatment depends. If the case prove to be one of acute perforated 
appendicitis, with incipient diffuse general peritonitis, the abdomen 
should be opened immediately, in the median line, the appendix 
excised, the abdominal cavity thoroughly flushed with hot saline 
solution, a glass drainage tube inserted and the wound closed. 
Drainage is absolutely necessary in these cases, as the peritonitis is 
always septic. In perforative appendicitis with encysted purulent 
peritonitis, suppuration rarely occurs before the fifth day and rupture 
of the resultant abscess into the peritoneum seldom takes place before 
the ninth day. The rapidity of the suppuration process bears a direct 
relation to the severity of the general symptoms — the more severe the 
general symptoms, the earlier the formation of pus. If the tempera- 
ture reaches 104 every evening for several successive days and does 
not fall below 102 in the morning, while the pulse keeps about 120, 
and there is some tumefaction in the region of the appendix, suppura- 
tion as early as the fifth day is probable and operation should not be 
deferred beyond the morning of the seventh day. If the evening 
temperature does not exceed 103 and the morning loj, the pulse 
var>'ing from 104 to 116 and the local swelling not increasing, opera- 
tion may be safely deferred until the ninth day. Exceptions to this 


rule will be rare. If from the sixth to the ninth day there. is 
some improvement in the general symptoms, but no improvement in 
the local signs, or, on the contrary, an increase in the local swelling, 
the surgeon should not be deceived by the apparent improvement; he 
should proceed to operate without delay. 

Acute catarrhal appendicitis. — Cases of acute catarrhal or inter- 
stitial appendicitis, with circumscribed plastic peritonitis, do not call 
for operative interference. Such cases are fatal only through the 
officiousness of the doctor. They probably constitute forty per cent, 
of all the cases of appendicitis met with in practice. 

Recurrent appendicitis is sometimes associated with a chronic 
catarrhal inflammation of the lower bowel, which is as often the cause 
of the patient's discomfort or suffering as is the diseased appendix. 
This condition calls for intelligent medical treatment. But when the 
recurrent attacks are plainly traceable to the diseased condition of the 
appendix, its removal is not only justifiable but imperative. In conclu> 
sion, I would state, that the treatment' of appendicitis does not be- 
long exclusively to either the physician or surgeon. The former is too 
prone to procrastinate and his procrastination may be paid for by the 
patient with his life. The latter has too great a tendency to resort 
immediately to his knife which is often unnecessary. Let the 
physician call the surgeon early and place upon him the responsibility 
of deciding when to operate, but let the surgeon appreciate the fact 
that he is not called merely as an operator — that it is to his judg- 
ment, not to his scalpel, that the physician appeals. 


By T. J. Smith, M.D., Bridgeton, N. J. 

Fell<yiv Members of the Medical Society of New Jersey : 

It is one of the duties of the presiding officer of this 
Society to present an address, upon some suitable subject, 
at the opening of this session of our meeting. It was 
with both diffidence and reluctance that I accepted the 
honor and obligations of this position, when I could not 
but think of my unfitness to preside over such a learned 
scientific body, a place which has been filled by some of 
its most distinguished and gifted members, and that I 
should be required to address you at this time from this 
chair. I candidly acknowledge that I feel a pride in the 
assurance you have given me, that you believe me worthy 
thus to assist in your deliberations, and that I may rely 
confidently upon your patience and generosity as we 
proceed with the duties before us. It would be ungra- 
cious in me to do so without first giving expression to the 
hearty sense of gratitude I feel for the honor done me, 
and for the many kindnesses that my medical brethren 
have many times heretofore accorded me. 

In assuming these responsibilities there came to me the 
thought of a subject, that has presented itself to my mind 
from time to time during the few years I have held the 
position of a director in the New Jersey Training School 
for Feeble Minded Children, and more particularly since 
the recent failure of the State executive to mature the 


plans of our legislature, making provision for the special 
care and treatment of a large element of the defective 
population of our State. I hope what I may say in dis- 
cussing a sociologic question will not appear misplaced in 
a purely medical presence. ' It surely relates to the medi- 
cal profession more than any other. 

Those of us whose lives are cast among the ruins of 
humanity, have our attention constantly drawn to the 
perversities that present themselves on every side. The 
man of exalted sympathy and humane aspirations won- 
ders why, in every age, these have been either abandoned 
to their fate or treated with neglect, as though they were 
all alike criminals or were laboring under some special 
judgment of heaven, with the sorrows and misfortunes of 
this life justly thrust upon them, knowing as he does, 
that they are, to a certain extent, susceptible of happi- 
ness, and that in the breasts of the worst there are germs 
of high and noble impulses. 

It is plainly the natural outgrowth of the thought that 
the weak are the rightful victims of the strong, that they 
have no claim upon the strong and that no one has any 
claims beyond those that can be maintained by one's own 
strength. Nature, it has been asserted, determines the 
inevitable doom of the weaklings and lets only the 
strongest survive, and, in the province of* morals, sets her 
face sternly against those weaklings who have yielded to 
their vices ; that it is useless to attempt to shield them, 
and that any effort to do so only results in perpetuating 
a grade of broken creatures who will merely increase the 
trouble of the world. 

The naturalist declares that only the fittest should sur- 
vive, and that all others must go to the wall. But we 
have something that surpasses pure naturalism. Charity 
is not natural, but supernatural. The assertion, " inas- 


president's address. 83 

much as you have, done it to the least of these, you have 
done it to me," coming from the impregnable rock of the 
divine charity, changes wholly the destiny of the help- 
less ; besides, these distressful creatures are but the fruit 
of our civilization. Their comfortless estate is but the 
result of those processes through which others achieve 
wealth, ease and refinement. No new enterprise is insti- 
tuted, no great work is accomplished without its comple- 
ment of desolation and ruin. Then why should not those 
endowed with strength and wisdom help uplift the weak 
ones, and why, in the day of adversity, should not these 
sacrifices of the race be cared for by the race ? This 
struggle of nature should be viewed, not as her purpose 
to exterminate the unfit person, but to reject the unfit 
ideas and principles that would preclude him from the 
survival of the fit. 

The problem of dependency, with a proper conception 
of its varied causes and results, has been a perplexing one 
ever since the inquiry, ** Am I my brother's keeper ** was 
first propounded. It presses more and more upon our 
attention, and in dealing with it we are dealing with one 
of the central problems of this age. 

What then is this problem with which we have to do ? 
The falling ranks of the human race are ever being re- 
placed with a certain proportion of the degenerate, the 
inefficient and the vicious. Shall the stringent processes 
of law or the gentler influences of benevolence prove to 
be the more successful agencies in dealing with such per- 
sons? Social reforms come slowly. It is much easier to 
walk in the old ways than to search out new ones or even 
to improve upon the old. All that is really valuable in 
the revision of old methods or in the adoption of new 
ones simplifies living and tends toward making life not a 
period of suffering, but a healthy and happy one. This 


process is cumulative, not destructive. It builds upon the 
old, not by impulsive changes, but by a silent growth 
that makes for better things. True reform is accom- 
plished by persistent effort wisely directed. Human suf- 
fering can be greatly relieved, if it will not be prevented 
or exterminated. The beauties of nature are lavishly 
spread abroad for man's happiness. The resources of this 
world for the comfort and welfare of her children are un- 
limited. There have been, and doubtless are now, those 
who believe that they contribute most to the worthiness 
of life, who add as much misery as may be to it. These, 
by their foolish fancies, only increase human neglect and 
drift us backward towards human barbarity. Many noble 
philanthropic movements are being hindered and blighted 
by those who ought, to be rather among the leaders of 

Did we recognize more fully the claims of the depend- 
ent upon our care and the full measure of our duty marked 
out by the voice of infinite compassion, we would feel 
more interest in the goodly number who are caring for 
the suffering ones of this world, who go down to the 
lowest intelligence and develop the little they may there 
find and who reach out after the degraded in order that 
they may lift up some one into the sunlight of love. 

The wonderful achievements m these directions, of the 
times in which we live, must lift our race to a higher 
plane of life and verify the marvelous results of elimina- 
tion and prevention toiling together under the master 
alchemist, charity. Providence has so compacted society 
together, so commingled in the same community, the 
talented and the incapable, the affluent and the needy; 
so ordained that all men are indiscriminately bound 
together, the intelligent and the idiot, the blind mute 
and the epileptic in one body politic : he so governs 

president's address. 85 

things that whether we would have it so or not, we are 
our brother's keeper. Prejudice and passion, with natural 
inequality of condition or ability, tend greatly to weaken 
the bonds of brotherhood, yet the fraternity of the race 
remains an undeniable fact. 

The spirit that breathes good will to men, declares for 
the revival of the unfit, the unfortunate and the defeated 
in the competition of life. This revival of the fitness 
to survive is the fundamental principle upon which the 
world is moving today in the development of modern 
methods of charitable work. It is the new science for 
whose transforming power the world is waiting. It is 
worthy of exact study as any of the accepted sciences. 
As the science of pathology must interpret the character- 
istic lesions in any bodily ailment, so in social degeneracy, 
the combative work needed must be preceded by a clear 
discernment of actual facts and experience. 

The work of Herbert Spencer on " Positive Benevo- 
lence, "declares, " the only thing that we are obliged to do 
by the law or by duty, is to help some one who may come 
across our path and be in need. ** The problem of depend- 
ency is not met by this teaching when considered from 
an economic point or from the humanitarian side of the 
subject. We cannot befriend one in want best by simply 
flinging a gift to him in passing. Far better for him is 
that aid which will relieve his needs without placing him 
in a position of dependence and that will, in its bestow- 
ment, tend to the improvement of character. 

We have here a real social force. It is founded upon a 
durable basis, for it rests upon the eternal verities. Its 
exercise only needs to be intelligently guided. The 
conscience may well be followed in this, not as a harsh 
master, but rather as a joyous instinct, which, like the 
thread that led Theseus out of the labyrinth and the 


dutches of the minotaur, will be a clue that will surely- 
lead the charitably disposed to the accomplishment of 
the greatest service. 

This force meets a new range of opportunity in our 
day. The wisdom of the pagan was opposed to any 
sentiment of philanthropy. ** Sapiens non miseretur," 
said Seneca. The pursuit of knowledge was his ideal 
condition of a perfect human life. Plato spoke apprecia- 
tively of the worth of friendship in the. promotion of a 
well ordered life. In his interpretation of the different 
virtues, there is no allusion to benevolence. Friendship 
was his highest ideal, especially that between pupil 
and master. He praised the physician who refused 
to lengthen the lives of defectives. The foundations 
of modern benevolent movements were laid in the 
transition from pagan to Christian civilization. Classic 
civilization knew nothing of the beautiful impulses por- 
trayed by the **caritas** which proceeded from this new 
belief. Upon the mighty truths then entering the minds 
of men, there followed, as a natural resultant, an entirely 
new conception of the brotherhood of man. The soli- 
darity of the race became an accepted fact. 

There has opened for us, at this day, an entirely new 
social environment, and new conditions requiring new 
rules of conduct. The problem of dependency then, in 
the vastly greater social complexity of modern life, 
assumes a twofold nature. There is the special force, 
the sense of duty with which to act, and there is the 
peculiar task to be done. The problem itself is to 
adjust this dynamic faculty to measures that will pro- 
mote the correction of the acquired and inherited defi- 
ciencies, just as science, for instance, has fitted the electric 
current in the physical world to her varied mechanical 

president's address. 87 

The responsibility of the more highly favored to the 
dependent classes, as we have stated, has been hereto- 
fore a casual sentiment, affording simply temporary relief. 
The more modern idea strives to look after their actual 
condition and rather than offer them only some tempo- 
rary gratification that can serve no good purpose, 
endeavor, by rendering uplifting aid through employ- 
ment and education, to. place them under more favorable 
conditions. It does not repress the sentiment but dis- 
ciplines it for more effective service. This sociologic 
problem thus assumes scientific significance and indeed, 
at its basis, seems to be largely an educational one. 

Such are some of the principles guiding modern phil- 
anthropic work for the dependent portion of our popu- 
lation. The work is a pleasurable one, for it may be 
the imparting of a new ambition to another human being, 
or a new incentive for another to rise to self dependence. 

At no period of our national life has there been so vital 
an interest felt in philanthropic study as at present. 
Our civic life is now undergoing a more thorough 
scrutiny than ever before. The investigator seeks for a 
solution of many questions with reference to the afflicted 
and disturbing elements of our population now sheltered 
in organized institutions and a still larger number remain- 
ing in their own homes, incapable from disease or other dis- 
ability, of filling any self-supporting occupation. Does the 
proportion of dependents diminish or increase? Has 
educational progress and religious advance made any 
perceptible impression upon this class ? What are phil- 
anthropic persons doing? What are the State authori- 
ties doing? Is there any part of this disturbing and 
disturbed element uncared for, and why? Killing the 
questioner might be a handy way to dispose of many 
worrying questions, but more than probable, it would be 


an unsatisfactory way. The question could thus only be 
put out of sight and not answered. 

No question is ever answered, 
Until it is answered right. 

The delinquents and the destitute are well cared for, 
the former by the repressive forces of society, and the 
latter supply a field peculiarly adapted to the exercise of 
private charitable agencies. The circlet of philanthropy 
has enclosed almost every division of the defective class 
except the sufferer from epilepsy. Something has been 
done for the care and improvement of the insane, the 
deaf mute, the blind and the feeble minded ; nothing to 
moderate the sufferings of the epileptic. He alone has 
been left to shift for himself. No methodic attempts 
have been made for his special care and treatment any- 
where until during very recent years. Why he has not 
before attracted the compassionate attention of humane 
men, I cannot understand. 

The object of this paper is to arouse the medical pro- 
fession of New Jersey and call their attention to these 
most unfortunate people and the great wrong done them 
in their continued neglect. If this wrong is ever to be 
righted, the power and influence of physicians will have 
very much to do with it. 

The life of an epileptic is essentially an isolated one. 
His presence in his own home is distressful and disturb- 
ing. In the home of poverty he becomes a grievous and 
heavy burden. He is a menace to the comfort and well- 
fare of any family. In the community, he is a source of 
untold annoyance. The public shun him lest they 
should be obliged to witness a convulsion. Even when 
capable, he is debarred from engaging in ordinary 
pursuits, as no one likes to employ an epileptic in any 
business or profession. He is unable to secure an educa- 


tion or learn a trade, whatever innate talent or ability 
he may possess. The privileges of the church and places 
of amusement are closed against him. He is shut out 
from social intercourse lest he give offense to society or 
be oflfended. Finally, with the progress of his peculiar 
malady hastened by his unhappy condition, and refused 
admission to general hospitals, he finds his way into the 
almshouse or insane asylum, where he becomes a charge 
upon the State for life. Nature seems to fasten her 
stigma upon him and his progeny as well — on one mem- 
ber as a criminal, on another as an imbecile, on a third 
as a consumptive, while a fourth may be an epileptic. 

It is not a continuous disease. There are many whose 
convulsive attacks constitute the entire malady. Fright- 
ful as are the brief periods of fainting and spasm that 
come unexpectedly, perhaps once or twice in a week or 
a month, in the interval between the seizures he is in 
full possession of his faculties and competent to attend to 
ordinary duties. Most usually these people are not dull; 
occasionally they have more than ordinary intelligence. 
They are always very sensitive to the impressions their 
condition provokes and look forward with dismay to the 
recurrence of their malady. It is a pitiable disposal of 
such persons, so fully conscious as they are that they 
deserve some better lot, to commit them to an almshouse 
or an insane asylum. In neither of these institutions, 
experience shows, is it possible for them to obtain either 
proper attention or treatment, and they are most likely 
there to soon deteriorate, physically, mentally and 
morally. They would seem to have peculiar claims upon 
the sympathy of every humane man and woman, and a 
Christian State may well make haste to seek out a 
remedy for so grievous a wrong done to so large a 
portion of her population. 


With a proper regard for the welfare of the community, 
it should be said that some of these epileptics, who are 
wholly sane and harmless between attacks, need to be 
restrained on their recurrence, when they may prove to 
be dangerous to themselves as well as to others. 

It is not my purpose to dwell upon the etiology or 
symptomatology of this 'disease, but to consider the 
question with reference to its social and medical features 
— how best to protect the community and at the same 
time do our duty to these unfortunate people. What 
is best for them is unquestionably more of a problem 
than for any other class. The conviction of those who 
have had the most experience in their care is that such 
conditions should be provided as might combine appro- 
priate medical supervision with wise industrial teaching 
and training. The problem would have been much 
nearer solution in our State, we think, had recent efTorts 
for the adoption of the moral treatment of epilepsy along 
this line not been frustrated by the veto power. It 
merited a better fate. A fuller consideration of its 
utility, both from an economical and a humanitarian 
standpoint, might rightly have been accorded it. The 
method suggested is undoubtedly the greatest stride 
forward yet in the therapeutics of this ailment. 

Epilepsy becomes exceptionally interesting in view of its 
antiquity and history. It seems to have afflicted man- 
kind in all ages and has been well recognized and des- 
cribed from the earliest times. Many opinions regarding 
it have been advanced by many different writers and yet 
not one opinion has survived and stood the test of 
general application. While the principal characteristics 
have been, in all times, practically uniform, no one has 
been able to detei^mine the nature of the brain lesion. 
We have, as yet, a small basis on which to found a 

president's address. 91 

cerebral pathology. Its nature and approximate causes 
are little better understood than they were twenty 
centuries ago. We know it only as a functional neurosis, 
a syndrome of a disease that may be produced by many 
entirely different conditions. It was thought by the 
ancients to be invoked by the gods or to have some con- 
nection with evil spirits, and was looked upon with 
terror or as a mystery ; hence the name, the " sacred 
disease." In Egypt and throughout the Roman Empire 
epileptics were worshipped as the possessors of supernat- 
ural powers. The disease was very prevalent in the 
beginning of the Christian era. The troubled father 
besought mercy for his son for ** he is an epileptic and 
sore vexed," for " ofttimes he falleth into the fire and oft 
into the water." Recurrences similar to this have con- 
tinued all along down the centuries since. 

Men with intellects far above the average, who have 
made a thorough success of their profession or business, 
have been tormented with epileptic convulsions. A 
learned professor in one of our medical colleges has been 
seized by paroxysms in the midst of a lecture. A 
shrewd and popular business man in New York, drawing 
a salary of twelve thousand dollars, some years ago was 
an epileptic. The late Pope Pius IX. was subject to the 
disease. Many well known literary and historical char- 
acters, as Petrarch, Moliere, Handel, Mahomet, Caesar, 
Napoleon and Byron, were troubled with the " failing 

The exaggerated dyscrasia may take the form of an 
uncontrollable propensity to the committal of criminal 
acts. There are many instances of the most astounding 
acuteness shown by such persons in the plotting of their 
vicious purposes. This frightful malady does not always 
discriminate between the different classes of society. 


Some of the best families and the noblest in society^ 
those with exceptionally good inheritances, are not ex- 
empt from its onset. Caesar, whom Froude describes 
finely as *' a type of complete manhood,'* became subject 
to epileptic fits. Gibbon, in his ** Mahomet," fully and 
curiously portrays the convulsions of the prophet and 
pointedly remarks that " some authors consider the fits 
as the principal evidence of his mission." 

Empiricism has had here a fine field in which to vaunt 
its bold theories and positive therapeutic measures, but 
has offered nothing reliable. The results of rational 
medicine have been almost as valueless. The promise of 
a cure, beyond that some of the more violent phenomena 
may be allayed, is, today, as distant as ever. Dr. Drewry,. 
of Virginia, a close observer, says: ** For eight years I 
have had under my constant care and treatment a goodly 
number of epileptics, and I am not certain that I can 
boast of having seen a single permanent recovery from 
true epilepsy, yet most all cases have been greatly im- 
proved." No disease is more unyielding to medical 
treatment alone, and none more amenable to improve- 
ment when appropriate hygienic and moral treatment 
is combined with the medical. How important, then,, 
that such provision should be made for these unfortunate 
ones as recent experience indicates is best suited to their 
especial needs. 

Epilepsy is much more prevalent than has been thought. 
There are probably at least two for every one thousand 
of our population — one hundred and thirty-five thousand 
in the United States, and from two to* three thousand in 
the State of New Jersey. Undoubtedly, five hundred of 
these are hidden away in private families, brooding over 
their frightful condition or confined in poor-houses or 
asylums without proper care and treatment, a financial 

president's address. 93 

burden on the State and a constant menace to the peace 
and safety of society. These are appalling statements to 
make in this enlightened age. The profession and the 
public should alike arouse to some speedy action in their 
behalf. Because the shadow may not have crossed our 
homes, shall we have no sympathy for and extend no help 
to these sorrowing ones ? I would plead especially for 
the poor and friendless and hopeless. Many, properly 
cared for at the proper time, might be greatly improved 
and made self-supporting, instead of burdens upon 
society. It required a very great deal of thought and 
experience to provide adequately for other defectives. 
All have been the recipients of humane legislation. The 
needs of epileptics are fully as exclusive, and it is one of 
the imperative demands of the day that they should be 
practically dealt with. 

The latest and more probable theory is that epilepsy 
is an affection of the cortex — not a disease in itself, but 
a symptom of cortical irritability. The epileptic is 
usually described as a very unamiable personage, while 
under judicious management he may be as agreeable as 
tiormal persons. His inconsistencies are the result of his 
irritability, which, with the accompanying mental weak- 
tiess, disguises in variable degree his natural disposition: 
His petulant temper is his characteristic symptom and 
the prominent indication for treatment. Medicinal reme- 
dies often fail to control these psychic disturbances. 
Many are even intolerant of drugs. Moral means are 
the only practicable resource. Their value is beyond 

To make definite what is implied in moral treatment, 
I cannot do better than quote from Dr. Spratling's annual 
report to the Board of Managers of Craig Colony. He 
there says: "Too much stress cannot be laid on the 


importance of requiring every epileptic whose physical 
condition will admit of it, to perform some kind of 
manual labor and do it systematically and continuously. 
Most of these people should be made to return, as far as 
possible, to a primitive condition of life, to a condition 
that eliminates the action of certain harmful stimuli 
incident to modern civilization that prompt nervous 
matter to abnormal action." The industrial colony 
system provides for just such moral treatment. It is a 
perfectly practicable and an eminently wise procedure. 
The economy of the scheme is shown by the experience 
gained at such institutions already in operation, and should 
thoroughly refute the worn-out objection to its expen- 
siveness. In the colony they are withdrawn from the 
disquieting gaze of the public and placed in a home of 
their own, where their associations and affiliations are 
mutual — just the beneficent environment needed to 
soothe their irritable, impulsive and emotional disposi- 
tions and resist the irregular nerve explosions, the basic 
symptoms of their neurotic disease. 

Dr. Geo. M. Gould says : " The only difficulty in 
speaking of this matter is not to say too much, or to 
speak in a manner not to seem exaggeration. That sys- 
tematic methods should be pursued in caring for epilep- 
tics, needs no further demonstration." Many eminent 
and experienced medical men hold a similar opinion. 
The people are in entire agreement on the subject. It is 
not always that doctors agree, perhaps seldomer yet that 
the professional and lay public are unanimous in anything. 

The place that would afford the special requirements 
needed by these stricken people is briefly and pertinently 
described by Dr. Frederic Peterson, the highest authority 
in this country. He says : " There is but one kind of 
institution which can meet the case of those who suffer 

president's address. 95 

with this disease. No asylum, no large hospital is appro- 
priate for the purpose. It must be an establishment 
combining many unusual features. It must have schools 
and teachers for the education of the young epileptics. 
It must have a farm, gardens, stores and shops of all 
kinds for, as they grow up, these patients should acquire 
an education and a trade. It must have a hospital where 
such as are sick or mentally infirm may be cared for. It 
must have skilled physicians. It must have, finally, a 
pathological laboratory presided over by the keenest 
pathologist obtainable, so that, in the course of time, a 
cause and a cure may be discovered for this terrible 

It is the general opinion that the State is best qualified 
to render this necessary care for its dependent epileptics, 
and that it is the duty of the State tp palliate, as far as 
possible, their wretched condition, must be conceded an 
ethical principle in any civilized -community. Next to 
the insane, they invoke most our human sympathies. 
The State authorities should be importuned most earnestly 
to revive the movement initiated by the legislature, for 
the establishment of an industrial epileptic colony in 
our State. Cannot the community-at-large be stirred 
to a just sense of their responsibility to these unhappy 
creatures? Will not the medical profession arouse to a 
proper sense of their obligation in the matter? That 
every State must, sooner or later, assume charge of its 
epileptics, certainly its poor, is, I think, undeniable, and 
the sooner it is done the better it will be for all concerned. 
We cannot afford to deal miserly with our unfortunates. 
The charities of the State should be as broad as the mis- 
fortunes of its citizens, and no class of the unfortunate 
should be left without provision for their wants. This, 
also, is preventive medicine — the benefit of the mass. 


secured through the representative capacity of the people. 
The recipients of these benefits would be : 

First. — The epileptics now confined in the two insane 
hospitals, numbering nearly two hundred. Their removal 
from those institutions would relieve the crowded 
accommodations there. 

Second. — All those in the city and county almshouses 
— probably two or three hundred more. 

Third. —A proportionate number of others from each 

Fourth. — After a while, arrangements might be made 
to receive pay patients* It should be the intention of 
the managers to extend the usefulness of the institution, 
as the way opened, to all who needed its specific help. 
There are several hundred dependent epileptics ready to 
enter the colony, were there one now opened for their 

What should the State expect from such a method of 
caring for her epileptics ? 

First. — That the colony would be made the seat of 
clinico-pathological researches of a high order, a place 
where this incurable disease could be more critically 
studied and the causes detected, if possible. At the 
Bielefeldt colony they claim an advance in the percent- 
age of cures from one to six, not regarding the patient as 
cured until the attacks have been stopped for four years, 
and sixty per cent, beyond the six per cent., greatly 
benefited. These may become worse again if they do 
not rigidly observe the colony habits of life. 

Second. — It would relieve many weary families, by 
taking from their hands the grievous burden of caring 
for their afflicted ones. 

Third. — That the preventive features of the system 
would check the terrible current of hereditary tendencies 

president's address. 97 

and the spread of neurotic diseases. The power of 
heredity in perpetuating a defect or a perfection, 
though occasionally denied, appears thoroughly estab- 
lished. It is illustrated in the development of the trot- 
ting horse, ** whose breeding is regulated with such nicety 
that the height, color, speed and even the cash value of 
a colt can be told almost to a certainty, before it is born." 
Echeverria gives the life histories of five hundred and 
fifty-three children of sixty-two male and seventy-four 
female epileptics as follows : Twenty-two were stillborn, 
one hundred and ninety-five died in infancy from spasms, 
seventy-eight lived as epileptics, eighteen lived as idiots, 
thirty-nine lived as paralytics, forty-five lived as hysteri- 
cal, six had chorea, eleven were insane, twenty-seven died 
young from other causes than nervous diseases and one 
hundred and five were healthy. Could a more convinc- 
ing story be told ! There is now no legal prevention 
against the epileptic, whose father and grandfather have 
been epileptics, from marrying a woman similarly 
afflicted and charging the bill to the public. From the 
more comprehensive study of the principles of hereditary 
transmission and their application to social science, may 
yet come ** those guiding lines which will turn the people 
aside from errors of living, falsities of believing and the 
indiscriminate license of marriage, all of which are gener- 
ating the large army of defectives." 

Fourth. — That it would demonstrate the practical 
economy of the plan. Bethel colony, the grandest 
charity in the world, nearly sustains itself in its great 
work. The value of the produce raised at Sonyea during 
their first year was equal to fifty per cent, of the entire 
cost of maintenance. The economical advantage of 
State custody is so assured by this testimony, that the 
question, can the State afford to enter upon such a 


scheme, must resolve itself into the conviction that she 
cannot refuse longer to do so. 

Fifth. — That it would marvelously augment the happi- 
ness and comfort of these afflicted people. They are 
practically outcasts. Even the church says, "you 
are disturbing the rest." The world of usefulness says, 
" we cannot employ you." In the colony they would 
have care and sympathy and work. Far better than 
bromides for the patients, is wholesome and steady 
occupation. Nothing hurts them more than being left 
alone with their thoughts, for in most cases they have a 
clear enough perception of their condition. A multi- 
plicity of occupations would tend to divert their minds 
from the contemplation of their misfortunes. The being 
occupied and the being of some use in self-help and in 
helping others, renders them distinctly happier, for life 
brightens and grows in value just in proportion as we 
know we are doing something worth doing. In his un- 
happy moods, the brighest individual never made much 
progress. It is reported of the one hundred and forty-five 
patients in Craig colony " that almost every beneficiary 
loses his dull apathetic look, born of idleness and neg- 
lect of years, when he begins to understand and appreci- 
ate the opportunities for occupation, education and 
treatment it oflfers." Surrounded by a sense of fellow- 
ship he learns to be content. His poor little skiff has 
run into a haven of peace. - Not every epileptic is com- 
petent to describe his own sufferings as Dostojewsky 
does in his novel " The Idiot," or to charm his fellow-men 
with music as did the epileptic Handel, or with comedy 
as did Moliere, or with poetry as Petrarch, or enthuse 
them with martial achievements as did Caesar and 
Napoleon, or inspire them with religious doctrines as did 
Mahomet and St. Paul, but many can pursue satisfact- 


orily some of the ordinary vocations of life. There would 
be no restraint in their colony home from the attainment 
of the highest mental improvement and from perfect 
freedom in making the best of life and the pursuit of 

It cannot be needful to contend longer before this 
body of progressive and representative physicians for the 
vital importance to them and to the community at large, 
of State care for epileptics. We have taken this occasion 
to put forth our best efforts for the promotion of a just 
public sentiment in favor of this dependent class. Public 
opinion, the potent power that accomplishes great deeds 
of mercy and benevolence, never arrays itself against the 
afflicted and suffering. 

I would call attention to the fact that the segregation 
of epileptics into a special home of their own has and is 
gaining in popular favor. 

The industrial system originated with a French clergy- 
man near Bordeaux, in 1848. Inspired by this worthy 
and successful example in France, the Bielefeldt epilep- 
tic colony was organized in 1869, with twelve patients. 
It has now twelve hundred, with at least thirty different 
vocations for men and twelve for women. The inmates 
are carefully graded and the institution has all the 
characteristics of home, family and natural life. A vivid 
description of it may be found in a recently published 
work by Julie Sutter. A number of these colonies of 
mercy have been established in Germany, France, Switzer- 
land, England, Holland and Sweden. The problem is com- 
ing into solution in several states of our Union. Ohio 
provided the first institution of the kind, exclusively by 
the State, in 1893. The Sonyea colony in New York soon 
followed, encouraged by the success achieved at Galli- 
polis. The last Massachusetts Legislature authorized 


the establishment of a home for epileptics at the public 
expense. Maryland . has commenced to develop an 
epileptic colony, which was organized by the King's 
Daughters of Baltimore. A farm of one hundred and 
ten acres has been purchased at Oakboume in Pennsyl- 
vania, and plans for a colony home are in course of pre- 
paration there. The initial step has been taken in 
Illinois, Wisconsin and Iowa, being prompted by their 
respective State medical societies to make special provi- 
sion for this purpose. California, Pennsylvania, Minne- 
sota and Michigan have arranged temporarily for the 
special care of epileptics in their State institution for 
the feeble minded. 

Moved by the suggestions in the excellent report of a 
commission appointed to investigate the subject, the legis- 
lature of New Jersey passed a bill in 1 896 preparatory to 
the formation of an epileptic colony in our State. This 
bill unfortunately met with the disapproval of the Gov- 
ernor, and the consummation of this humane charity for 
the relief of the five hundred epileptics now upon public 
charge in New Jersey will be delayed for a time. The 
friends of the bill were disappointed. This. Society, at 
its meeting one year ago, recorded its sorrow and regret 
over the failure of the measure, after its passage through 
both houses of the legislature, and resolved to put forth 
its best endeavor to bring about the enactment of 
another similar bill. No one doubts the justice of the 
scheme. Public opinion is enlarging upon the subject, 
and like Banquo's ghost, will not be. put down. Let us, 
as representatives of the medical profession in New 
Jersey, take some practical step toward bringing this 
question forward again. Physicians will have great 
influence, when aroused to a true sense of responsibility, 
in directing public sentiment and in securing better 


results for another effort. Dr. Gould says, on this point: 
** If only the earnest workers in practical medicine, those 
conscientiously striving to limit the woes of their fellow- 
men, would give this reform their attention and active 
support, practical results would infallibly follow. It 
seems a subject eminently proper and worthy of being 
considered by medical societies.'* 

Will New Jersey, progressive in almost everything, and 
profuse in her charities, allow this wholesome and neces- 
sary measure of relief to wait long for its complete ful- 
fillment ? It appears to me that asylums and refuges 
should be considered as indispensable to the State, as 
field and general hospitals are to a thoroughly equipped 
army. Can the cry of these unfortunates continue its 
appeal much longer to the ear of justice and humanity, 
with few hands stretched out to help them? Surely, no 
one will venture to discourage any determined effort you 
may make to hasten the glad day of hope for these 
bound ones. Unquestionably the " comfort ye, comfort 
ye,'* was written for this people also. " Whoso stoppeth 
his ears at the cry of the poor, he also shall cry himself 
but shall not be heard." 

We all need to be reminded of the justice and benefi- 
cence of the propositions here set forth. When the obliga- 
tion for merciful legislation therein implied, is recognized 
and the humane principle enunciated by the Scottish judge 
in 1724, that all defectives are wards of the State, shall be 
incorporated in constitutional enactment, then, I think, 
the problem of dependency will have come wondrously 
near being wrought out in our commonwealth. 

The higher the state of civilzation, the greater will be 
the differentiation between the grades of the defectives 
and the more intelligent the methods of care in dealing 
with them. A physician proposing, in these days, a 


rational treatment, does not endeavor simply to assuage 
the symptoms ; he tries to restore the normal condition 
of the system. True charity, in her best efforts, strives 
most to bring about better conditions. She catches the 
spirit of the incident at the pool of Bethesda and offers, 
rather, an opportunity for improved conditions — an in- 
spiration of a desire for self-reliance and self-help. 
When society is thus active we may hope to see the ever 
progressive spirit of the Nazarene pervading every-day 

The story of the cynic is that when the virtues met in 
a better sphere, charity asked to be introduced to grati- 
tude. She believed they had never met before. The 
cynic errs. He had mistaken the emotion of pity for 
charity. Pity expresses itself unthoughtedly. Real char- 
ity directs the emotion along definite economic lines and 
leads eventually to the molding of character. As men 
view her thus, they will become acquainted with the 
sweet virtue, charity, and will observe that she is always 
accompanied by her gentle sister, gratitude. 

Every good man is interested in the welfare of his 
country. It is well that each one should thoughtfully 
reflect upon the impression his own life is going to have 
on the destiny of the State. We are often disposed to 
think that the best results are attained through some 
political organization, or the noisy clamor of presuming 
reformers, or that advancement is best secured through 
an arrogant decision of all vexatious issues. If it is true 
that "the real forces which control the world are the 
silent forces," we must put a different estimate upon 
those ordinarily considered potent in this direction. I 
remember well the grand demonstration of human power 
displayed by the Corliss engine in Machinery Hall, but the 
silent forces that keep the myriad bodies of the universe 

president's address. 103 

in harmonious movement, are incomparably a grander 
exposition of power. So, then, the fate that awaits us as 
a people, the impress that our lives are going to have in 
the molding of character and in the conferment of hap- 
piness and contentment upon those about us, will be 
wrought out by those silent^ but irresistible influences 
which make for peace and good-will among men, by 
those quiet lives working out their hallowed purpose in 
these charities, the evidences of a practical faith and the 
promoters of moral forces that will yet, in good time, 
regenerate the race. When the deeds of men and the 
achievements of nations come to be recorded in the 
future, the writer will not be consonant with the facts of 
history when he tells us only of those who have won 
great names in legislative halls or done famous deeds on 
the battlefield ; he must tell of the intense devotion of 
those earnest lives, content to be unknown, if only the 
world can be made better through their service. The 
prestige of such lives will have the most to do in working 
out the social problems that arise as the years go by* 
All trouble and sorrow incident to this life will one day 
be transformed injto joy as " the genial twinkle of stars 
that cheer our night is merged in the light of the sun.** 
Robert Browning says in " Rabbi Ben Ezra **: 

The best is yet to be. 
The last of life for which 
The first was made ; 
Our times are in his hand 
Who saith a whole I planned. 
Youth shows but half ; trust God. 
See all, nor be afraid ! 



The Value of Antitoxin as a Remedial Agent 
AND AS A Protection Against Diphtheria.* 

The pertinence of this inquiry was, probably, greater 
one year ago than at the present time, because certain 
matters have not until recently, been subjected to practi- 
cal tests in the daily practice of many physicians. A 
year ago it was a sincere and yearning inquiry arising 
from every mother which animates medical men to do 
their best under all circumstances of professional duty. 
It is yet an important inquiry for all of those who have 
not followed the literature of the subject closely or had 
opportunity to make many clinical observations in this 
direct line of study. 

We may assume that antitoxin is a recognized remedial 
agent, and that the scientific circles of our profession 
have accepted, on some basis, with more or less limita- 
tions, the protective character of the agent against 
diphtheria. The prescribed question, however, requires 
us to verify the remedial quality and prove the prophy- 
lactic efficacy of antitoxin by means that will necessarily 
furnish some evidence of consequence as to how much 
this new remedy is worth in our arsenal of weapons 
against disease. 

♦Fellows' Prize Essay of the Medical Society of New Jersey, for 1896. 


Up to March 14, 1894, the veterans of our profession 
had not been called upon to contemplate any very- 
radical departure from the routine methods that their 
respective experiences had formulated for the treatment 
of diphtheria. Much serious attention to this insidious 
and formidable disease had afforded them a fair degree 
of confidence and satisfaction in its treatment. The 
common sentiment among physicians, who were compe- 
tent and quick in their diagnoses, was that they were as 
well prepared to cope with diphtheria as with almost any 
form of malady which demanded instant recognition and 
effective action in order to prevent serious consequences. 

Statements of cures, under preferred and highly vaunted 
forms of treatment of diphtheria in communities or dis- 
tricts where the disease had become alarmingly prevalent, 
were to be found in all the medical journals. 

The mortality has certainly seemed to be lessening, 
and the greater satisfaction was derived from the then 
prevailing belief that certain judicious modifications and 
amalgamations of the many excellent plans of treatment, 
then approved by worthy testimony, would surely lead 
to a reasonable repression of diphtheria, if not to its local 

These measures that were doing such good work and 
which gave security to all except a certain percentage of 
ultra-malignant cases, or to such as were not reported to 
the physician in time, were those that brought hito use 
all the available antiseptic agencies that were to be 
found in endless profusion, all the topical abortives of 
which the chlorates and chlorides, the sulphates and 
sulphites, the phosphates and hypophosphites, the bro- 
mides and iodides are typical examples. 

The concentration and elegance of some of these well- 
known pharmaceutical preparations made them especi- 

ESSAY, 107 

ally serviceable and satisfactory in the hands of the medi- 
cal practitioner, and his "happy results" were all-consol- 
ing while he entertained the impression that there was no 
specific remedy, either to be looked for or desired. The 
average physician believed that there must of necessity 
be a certain diminishing, but always rather large percent- 
age of fatal cases in such a disease as diphtheria. 

This confidence in the prevalent measures of treatment 
and of prophylaxis previous to March 14, 1894, led many 
very honest and faithful practitioners not only to dis- 
trust but to regard, almost with aversion, the earlier 
announcements of the positive antagonism of the serum 
derivative, called antitoxin, when applied to quench the 
specific germ of diphtheria. The practical failure of 
Koch's ** Tuberculin," and some positive antipathy to 
Pasteur's treatment of rabies, with perhaps no well 
assured knowledge of his (Pasteur's) triumphs against 
anthrax and fowl-cholera, kept the professional mind 
sceptical concerning the true worth of antitoxin. 

All this was very natural, but, to a certain extent, 
reprehensible. With questions of bane and anti-bane in 
the hands of expert scientists, true to their technical 
knowledge and well trained instincts, it would have been 
vastly more creditable to discern good ground for hope 
and cultivate some unquestioning faith. 

The researches of r^rofessor Virchow of late years in 
the region where speculation has ceased and nothing but 
cold facts confront the observer — the dead house — are, 
in the nature of things, likely to bring about a chilliness 
among the ardent advocates of a potent but thus far im- 
perfectly understood, product of the laboratory. Some 
of the more prudent biologists, to be sure, are distinctly 
cautious in their predictions respecting the ultimate re- 
sults of almost any of their experiments. One is fain to 


regret that more observers do not emulate the great 
Darwin in his methods of investigation, and in the spirit 
of utter self-abnegation with which they are characr 

We all know the dangers of a half-digested scheme for 
the restoration of health — the folly of a great deal of 
medical journalism — and feel assured that it is prone to 
accomplish more harm than good, and to quote a current 
writer, " is liable to lay an author under the imputation 
that his vanity has got the better of his philanthropy.** 

A disturbing element in calculating the effect of all 
remedies, to say nothing of the fallibility of diagnostic- 
ians, is the frequently unknown quantity termed self- 
limitation. And, too, we are apt to forget that it is not 
the eye but rather the mind that sees, and consequently 
the wishes are strongly inclined to dominate the vision. 
So the prevalent distrust is worthy of some apology and 
is a balance-wheel of no insignificant importance in 
determining the actual worth of all that sets previous 
acquirements, well founded impressions and personal 
experience at defiance. Enlightenment, however, will 
easily penetrate the cultured mind. The law of evidence 
will sooner or later establish the law of truth. 

It has been the exhaustive studies of Dr. Hans 
Aronson that have enabled us to employ the new serum- 
therapy in the treatment and prophylaxis of diphtheria. 
The results he obtained are recorded in a series of articles 
which appear in the ** Berliner Klinische Wochenschrift,*' 
1893, No. 25, and Nos* 15, 18 and 19, 1894. These 
experiments began in 1892, and were conducted in the 
physiological laboratory of Professor Zuntz, at Berlin. 

To Behring belongs the credit of the fundamental dis- 
covery that the blood of an animal immunized for 
la certain infectious disease may be employed for 

ESSAY. 109 

protective vaccination, and even, in larger quantity, 
exercise a certain influence after infection has occurred. 
This will always remain one of the greatest discoveries 
by which scientific medicine has been enriched in recent 
years, even if the practical results in the human infectious 
diseases, that we confidently expect, should not be 
obtained. It is especially in the case of diphtheria that 
the discovery has been applied in the attempt to prevent 
and mitigate the ravages of the dread disease. 

It has long been known that the diphtheria bacilli 
differed in virulence in different cases. Brieger and 
Frankel, " Berl. Kl. Wochenschrift," 1890, p. 344, proved 
that fact in 1890, and Roux and Gerdin "Annales de 
rinstitut Pasteur," 1890, p. 385, gave more exact data on 
the subject shortly thereafter, in their masterly researches 
on the organism in question. The more exact determi- 
nation of the degree of virulence was made by Behring 
and Wernicke, " Zeitschrift f. Hygiene und Infectious 
Krankheiter,*' 1892, Vol. XII. They fixed the dosage of 
a two-days bouillon culture that was required to kill a 

The following is an abstract of Dr. Aronson's re- 
searches: He began by employing Behring's method to 
ascertain the virulence of the diphtheria cultures, which 
were grown either on Loeffler serum .or Koch's bouillon. 
A minute quantity of such a culture he transferred to a 
sterilized glass tube and allowed it to remain two days in 
the incubator. A series of guinea-pigs were then in- 
jected with various dilutions of the cultures, and the 
quantity requisite to kill the animals in four or five days 
determined. This was some three times more powerful 
than the minimum fatal dose, or the dose that kills in two 
days, and was a more useful measure for his purposes. 
The weight of each animal was also exactly determined, 


for the lethal dose in equal periods of time must be 
proportioned thereto. 

Examined under these conditions, it was found that 
diphtheria cultures from different cases showed very 
varying degrees of virulence. There are diphtheria 
bacilli of which i-2 c. cm. will kill in four days a guinea- 
pig weighing some 300 grms. This varying virulence 
explains the protean nature of the disease, and. the 
differing character of the various epidemics. It also 
helps us to understand the occurrence of diphtheria 
bacilli in rhinitis-fibrinosa and other benign affections. 
Now, it was found possible to change artificial diphtheria 
cultures to weaker or stronger degrees of virulence. 
The virulence is increased by inoculating guinea-pigs, 
and after their death inoculating a number of serum tubes 
with small particles taken from the hemorrhagic oede- 
matus tissue near the site of the injection. When this is 
done in a series of cases^ cultures of which O-i c. cm. 
killed a guinea-pig of medium size in four days, can be 
changed into such of which 0.008-0.009 c. cm. would 
have the same effect. The value of these very poisonous 
cultures for effecting immunity will soon be apparent. 

The decrease of the bacterial virulence is just as im- 
portant. Roux and Ofersin have described a complicated 
method to effect this, which, in general terms,- consists of 
artificial cultivation in bouillon at an elevated temper- 
ature (39.5^ c), with the simultaneous passage through 
it of a current of air. Aronson demonstrated in 1892 
(** Berliner Klinische Wochenschrift," No. 32, 1892), a 
simpler and more elegant method of effecting the same 
object. It consisted of the use of the antiseptic vapors of 
formaldehyde (formalin). By arranging the liquid form- 
aldehyde in drops on the surface of the serum, and 
varying the concentration of the antiseptic solution, the 

ESSAY. 1 1 1 

colonies that were sown would develop slowly or not at 
all. He called attention at that time to the lessening of 
the virulence of the cultures in accordance with the con- 
centration of the formaldehyde solution, the length of 
time it was permitted to act, and the height of the layer 
of serum. 

His immunization experiments may be described as 
follows : The immunization of small animals, very sus- 
ceptible to diphtheria, is a matter of great difficulty, and 
therefore, Aronson selected larger and less susceptible 
subjects: Dogs appeared especially suitable, and his first 
experiment on a large one, weighing 27 kg., was success- 
ful beyond expectation. It turned out later that dogs 
were amongst the most susceptible subjects, if we com- 
pared their body-weight with the minimum fatal dose ; 
and Roux and Yersin had already mentioned the fact. 
He found finally that the fatal dose of diphtheria per 
kilogramme was only about twice that required for 
the notoriously susceptible guinea-pigs. The suscepti- 
bility of dogs varies with age and race, but within very 
narrow limits. 

The symptoms and the post-mortem findings in the 
diphtheria-inoculated dogs varied with the severity of 
the infection. If the dose is many times the fatal min- 
imum one, the animals become anorexic on the day, 
appear sick and tired, and are soon unable to stand. 
Intense icterus not unfrequently occurs, and the animals 
die in a few days. The post-mortem shows an extensive 
doughy oedema of the subcutaneous connective tissue 
around the site of the injection, with many hemorrhagic 
foci scattered through it. There are multiple hemor- 
rhages in the intestinal walls, and enlarged suprarenals 
and parenchymatous hepatitis and nephritis, with album- 
inous urine, is present. When smaller doses are emr 


ployed, or when the animal has been previously 
immunized, the symptoms are different. The general 
health is but little disturbed ; there is more or less 
swelling around the seat of injection. In the course of 
one or two weeks the skin, for a varying extent around, 
loses its hair, turns red, finally becoming black and dry. 
The dogs may survive, but usually they die of marasmus. 

In the former case the necrotic skin is sloughed off, 
and the resulting ulceration heals under appropriate 
treatment. But the dog remains thin and eats badly, 
and in three or four weeks there appear marked and 
characteristic paralytic symptoms. There is weakness and 
ataxia of the hind limbs, anorexia, frequent vomiting 
and impeded respiration, the whole forming a symptom- 
complex that those experienced in the diseases of dogs 
will surely consider as quite peculiar. The post-mortem 
is negative, or shows no typical changes. 

Dogs may be protected against diphtheria infection in 
various ways : 

(a) By the use of ordinary diphtheria cultures, espec- 
ially the weaker kinds obtained as above described 

{i) By treatment before infection with artificially 
weakened living cultures. Aronson recorded such a case, 
and since his writing there have been a great number of 
such cases recorded. 

{c) The administration of large quantities of fully 
virulent diphtheria bouillon per os. This has been ex- 
tensively used by all experimenters. On account, how- 
ever, of the large amounts of diphtheria bouillon that 
have been employed, this method of immunization is too 
expensive for practical use. 

Of these various methods of producing immunity in 
the larger animals, Aronson preferred and employed only 
the method with the formaldehyde fumes. He did not 

ESSAY. 113 

doubt, however, that by means of chemicals, high tem- 
peratures, etc., a weakened diphtheria virus might be 
obtained that would give equally good results. 

There is another method which, though not important 
for the immunization of the larger animals, is, theoreti- 
cally, very interesting. It relates to the immunizing 
agencies of certain cultures devised by Kitisato and 
Vaillard. Vaillard corrected some joint experiments 
that he had made with Kitisato and found, finally, that 
the injection of large amounts of virulent tetanus cul- 
ture did cause the appearance in the blood of true 
immunizing materials. 

Aronson has done the same thing for diphtheria. 
White rats, as Loeffler and all subsequent authorities 
have found, are immune against diphtheria, and his own 
experience coincides with theirs. He has injected large 
quantities of highly virulent diphtheria culture into 
these animals without noticing any subsequent symptoms 
of disease. Nevertheless, in one or two months, immun- 
izing substances, in not inconsiderable quantities, could 
be observed in their blood, and may be used to immunize 
guinea-pigs. This proved the highly important fact 
that in diphtheria the antitoxic was produced in the 
blood of naturally immune animals, provided that con- 
siderable amounts of virulent cultures had previously 
been administered to them. Even the blood of un- 
treated rats has a certain protective influence, and while 
this has been denied by some, yet it has surely been 
observed that there is an appreciable protection, because 
death occurred perceptibly later in diphtheritic guinea- 
pigs to which it had been administered. 

Now, there is a method" of increasing this acquired 
immunity. It is not enough to bring an animal to the 
point that it survives the ordinarily fatal dose of the 



diphtheritic poison. A larger dose would still kill it: It 
is Ehrlich's merit to have determined this method and to 
have expressed its terms numerically. In his researches 
on Ricin ("Deutsche Medicinische Wochenschrift," 1891, 
p. 976), he has shown us how to hetighten an acquired 
immunity by the careful administration of gradually 
increasing doses of the poison. 

Many investigators have employed this method in the 
various infectious diseases, and it is perfectly practicable 
with diphtheria bouillon cultures employed on dogs. 

All this is highly interesting and instructive matter 
when fully studied, analyzed and applied. Aronson 
commonly selected the method of central arterial 
infusion ; withdrawing blood for the purpose of obtain- 
ing serum, and inducing morphia narcosis that his 
operations might not be interrupted by any incident that 
would prejudice the success of the experiment. The 
technique of the operation does not require rehearsal at 
this time. 

Now, experiment has proved, beyond peradventure, 
that with the heightening of the degree of immunity, 
L e,j with the increase of the amount of diphtheria 
poison that can be taken without damage, the immuniz- 
ing value of the blood serum increases. To increase 
immunity, the most poisonous cultures, which have been 
in the incubator for six or eight weeks, are required. 
Aronson corrected his earlier and weaker tests — the im- 
munizing value of which was described under the title of 
*' Normal Serum " — and obtained a more pronounced 
toxic serum of positive immunizing efficacy. 

Nevertheless, infection with living bouillon cultures is 
not reliable as a standard of measurement, since the 
power of such cultures may vary greatly within a short 
space of time. The diphtheria poison itself should be 

ESSAY. 1 1 5 

employed. The active substances must be isolated from 
the larger quantities of the blood serum of immunized 

Fluid blood serum is so decomposable and difficult to 
keep aseptic that it would be a great advance along the 
entire line of the serum therapy, if we could substitute 
solid bodies of identical properties with that of the fluid. 
But for practical use it is necessary that the solutions of 
these antitoxic bodies should be more powerful than the 
blood serum from which they are derived. Before refine- 
ments of the laboratory are attempted, let us become 
fully acquainted with the underlying facts of the oper- 
ations of the toxic and antitoxic agents, no matter how 
crudely they now present themselves. On some accounts, 
but, perhaps, not so much connected with their study, 
the imagination cannot suggest any solution of the im- 
munizing agents more suitable for injection than that 
which we already possess in the blood serum. 

Aronson has done some experiments which we learn 
have resulted in the preparation of antitoxins in solid 
form, which give better results, both as regards concen- 
tration and aniount, than all previous ones. These points 
are not important in our present discussion, but it is 
interesting to consider the fact that from a serum of 
given value we have obtained well-defined and staple 
bodies of one hundred times the potency of all fluid 
cultures under any estimate we may make of their 
essential properties in their liquid form. 

It is needless to discuss the question whether diph- 
theria is easier or harder to cure in guinea-pigs than in 
man. A priori it would appear to be harder, since only 
forty to forty-five per cent, of human cases die ; whilst 
in our artificial infection ;of the animals they all invari- 
ably die. 


All the animal experiments show that the results are 
better the earlier the treatment is commenced ; the dose 
necessary for cure in an infection of medium severity 
increases tenfold for every day that we neglect treatment. 

We need not, therefore, be surprised if the results in 
the dispensary service are not as satisfactory as those in 
private practice, since many of the patients are already 
in an advanced stage of the disease before they are 
attended by a practitioner fully prepared to do 
them good. Often they are on the verge of dissolution 
before adequate help can be obtained from the charity 
service of many communities. When the septic con- 
dition, due to secondary mixed infection, has set in, we 
need expect no result from a specific treatment directed 
against the diphtheria poison alone. 

In all infective diseases that have been so far studied, 
the serum of immunized animals or cured human beings 
is protective against infection with the living organism of 
disease, but only in diphtheria and tetanus is it effective 
against infection with the sterilized poison that these 
organisms produce. Whatever our theories for this may 
be, they are nevertheless not proven facts, though the 
main fact, as first given, remains established beyond 

Buchner has expressed his hope and belief that we 
shall eventually obtain the curative bodies directly from 
our cultures, without the intermediary influence of the 
animal body. 

According to any theory, it is probable that the de- 
rangement and damage of cell structure are the cause of 
the paresis so rapidly supervening upon the inception of 
diphtheria poison. If treatment is begun only when the 
cells have already undergone the maximum amount of 
damage they can bear, and when they nepd no further 

ESSAY. 117 

damage to die, we will effect nothing by the administra- 
tion of even the largest doses of the antitoxin. Hence, 
it is now conceded that it is useless to attempt to cure 
diphtheritic paralysis withantitoxin ; there is a demon- 
strable pathologico-anatomical change, and the remedy 
has no reparative power. If, however, the specific treat- 
ment is begun early enough, there is hope of preventing 
the appearance of the paresis. 

Antitoxin effects the direct and immediate destruction 
of the diphtheritic poison within the compass of its 
relative power to the poisonous element as determined 
by its strength and quantity. Inherent strength and 
proportionate quantity to the volume and power of the 
poison to be antagonized will surely neutralize the 
poison at any stage of its deadly progress. What that 
poison has been allowed to do of a detrimental character 
to the system before the antitoxin is administered, is 
quite another question. The remedy destroys the 
poison, and is correctly called the diphtheritic anti- 

So extensive have been the laboratory experiments 
within the past two years, especially in Germany, all 
tending to confirm the potent energy as a germicide in 
diphtheria of the diphtheritic antitoxin, that we have 
only to make ourselves acquainted with these luminous 
showings to be convinced of the absolute necessity of 
confronting diphtheria with the new remedy. Labora- 
tory observation has proved that old and very poisonous 
cultures are to be preferred from which to obtain a serum 
of the highest protective value. Virulent diphtheria 
cultures are absolutely necessary. These are obtained 
only by time, often many months, when the acid reaction 
of the culture has had time to become intensely alkaline. 
Very recent methods have devised effectual means of 


intensifying cultures without the expense of very incon- 
venient periods of time. Alkaline reaction can now be 
made to appear in a few days. 

In diphtheria the difficulties are greater than with any 
other infectious disease in attaining immunization. In 
every stage, and with the greatest exercise of care, the 
danger of causing a too violent and fatal reaction is 
present. The well-known after effects of diphtheria in 
the human race lessens our surprise at the fact that ani- 
mals who show neither temperature nor local reaction 
after the injection, sometimes die fourteen days later, 
and that without any assignable cause being found post- 
mortem. Months upon months have been patiently 
spent in the exact adjustments of laboratory products to 
the supposed or ascertained force and fury of the disease 
to be antagonized, and the work has not been in vain, as 
shown by the perfect tables of measures or potencies as 
opposed to the definite conditions of the infectious disease 
in all shades of virulence and stages of progress. 

Thus far we have seen that we are not dealing with a 
wild superstition nor with an extravagant and fanciful 
theory. Definite records, as truthful as the archives of 
history, have afforded the student ample proof of the 
energy, the antidotal character and also the safest thera- 
peutical adjustments of the anti-diphtheritic agent called 
antitoxin. Let us look, now, briefly, to the clinical evi- 
dences of its value in practice, and we have answered, to 
the best of our ability, the questions as propounded by the 
Fellows' Prize Essay Committee of the Medical Society 
of New Jersey, of 1896. In June, 1894, a wonderful 
report was read, and afterwards published, of the clinical 
observations and results that had already been obtained 
from antitoxin in the treatment of diphtheria in the 
Emperor and Empress Frederick Children's Hospital, in 

ESSAY. 1 19 

Berlin. Dr. Otto Katz presented the report, which was 
read before the Berlin Medical Society, at the suggestion 
of his chief professor, Baginsky, and with the official 
sanction of the Honorary President of the Berlin Medical 
Society, Prof. Virchow, to whom it had been submitted. 
Every attention to detail, both of practice and observa- 
tion, is in ample evidence in that remarkable report. 
This, of itself, would seem to be a sufficient clinical expo- 
sition of the unqualified value of antitoxin in the treat- 
ment of diphtheria, as well as of the protective value of 
antitoxin when used in prophylaxis. The report is 
obtainable and need not be drawn upon in this paper for 
any evidence, pro or con. 

The report from Willard Parker Hospital, of New York, 
contained in a report made to the Board of Health of 
New York City as early as 1894, and published in the 
** Medical Record " of November 17, 1894, affords abund- 
ant confirmatory proof of the immense clinical value of 
antitoxin. With ready access to this valuable report, it 
is not necessary to quote from it a single line. American 
and English physicians are constantly adding the weight 
of their testimony to the volume of evidence in favor of 
the best quality of the antitoxin of diphtheria. The 
laboratory products of New York, not to mention those 
of other places, are now standard preparations that rival, 
successfully, those of Germany or France, where the 
needs of serum therapy are to be provided for in quality 
and abundance not to be gainsaid. 

In the practice of the writer he gave antitoxin in the 
treatment of diphtheria as soon as he was able to obtain 
it. He confesses to some reluctance to using it until 
forced by an accumulation of convincing evidences 
received through reading, and some personal laboratory 
observation, to lay aside all disinclination and give it 


such a test as previous intelligent clinical experiences of 
others satisfactorily guaranteed. He had arrived at a 
period of some personal content in the treatment of diph- 
theria by the old-fashioned pharmaceutical methods, with 
the enormous advantages of the aid of trained nurses 
and isolation, associated with most scrupulous hygiene 
under antiseptic measures. Still the percentage of deaths 
exceeded many times the proportion of fatal cases of 
those reported from Europe in the series of cases treated 
by antitoxin. There was an influence also brought to 
bear in consequence of the wide and rapid diffusion of 
the knowledge among the public that there existed a 
specific remedial agent for the terrible scourge of diph- 
theria. The question began to be asked by anxious 
parents, "Do you use antitoxin?" The writer was 
obliged soon to be able to say, " Yes, I do use it." That 
measure of social coercion has never been regretted by 
me. The main clinical points of seven of the cases 
which are the latest, in consecutive order, just previous 
to the preparation of this paper, and all occurring within 
the past twelve months, in the private practice of the 
author, are as follows : 

No. I. Female ; age, 6 years ; date of injection, second 
day ; dose, lo c. cm.; other treatment, vigorous local and 
internal ; type of case, severe ; result, perfect and speedy 
recovery; bacteriology, culture test, Klebs-Loeffler bacillus. 

No. 2. Male ; age, 7 years ; date of injection, third 
day ; dose 5 c. cm.; other treatment, vigorous local and 
internal ; type of case, severe ; result, rapid recovery, 
quite well on the sixth day ; bacteriology, culture test, 
Klebs-Lceffler bacillus. 

No. 3. Male; age, 5^ years; date of injection, second 
day ; dose, 5 c. cm.; other treatment, none after injec- 
tion ; type of case, average ; result, speedy recovery ; 
bacteriology, culture test, Klebs-LcefHer bacillus. 

ESSAY. 121 

No. 4. Female ; age, 3 years ; date of injection, second 
day ; dose, 5 c. cm.; other treatment, none after injection; 
type of case, average ; result, speedy recovery, very well 
in 10 days; bacteriology, culture test, Klebs-LcefHer 

No. 5. Male; age, gi years; date of injection, one 
dose the third day, and after 10 day intervals, two more 
doses; dose, ist, 10 c. cm.; 2d, 5 c. cm.; 3d, 5 c. cm.; total, 
20 c. cm.; other treatment, vigorous local and internal ; 
type of case, severe ; result, perfect recovery, but very 
prolonged invalescence — eight weeks from seizure to end 
of all treatment; bacteriology, 3 culture tests, in each 
Klebs-LoefHer bacillus. 

No. 6. Female ; age, adult (mother of Case No. 5) ; 
date of injection, second day; dose, 10 c. cm.; other 
treatment, none after injection, except rest, decubitus and 
nutritious diet ; type of case, average ; result, speedy 
recovery; bacteriology, culture test, Klebs-Loeffler bacillus. 

No. 7. Female ; age, 9 years ; date of injection, second 
day ; dose, 5 c. cm.; other treatment, active general sup- 
porting treatment ; type of case, severe ; result, good 
but tardy recovery ; bacteriology, culture test, Klebs- 
Loeffler bacillus. 

Culture tests were demonstrative under the orders and 
reports of the local Board of Health. There could be 
no such showing in seven consecutive cases of equal 
severity if the old treatment alone had been pursued. 
In fact, the old treatment in these cases had practically 
been ignored, although a prompt and vigorous use of 
many of the elegant antiseptic lotions, solvents and stimu- 
lating restoratives known in ** up-to-date " pharmacy and 
practice was made. They helped to allay apprehension, 
conserve languishing energies and confer important sanita- 
tion upon patients and caretakers. The following discus- 


sion, which we crave to quote in part, in the Berlin Medical 
Society, at a meeting on December 5, 1894, reported in 
the "British Medical Journal," December 15, 1894, will 
exhibit the well digested views' of two eminent men who 
have, perhaps, no equals in the theoretical as well as the 
practical departments of our profession — Von Bergmann 
and Virchow. 

Von Bergmann was the first speaker. He denied 
Hausemann's assertion that the Lceffler bacillus was not 
to be found in every carefully examined case of real 
Bretonneau diphtheria. In 430 cases of diphtheria out 
of a series of 450 cases, the LoefHer bacillus had been 
found. In his opinion, the Lceffler bacillus was undoubt- 
edly the cause of diphtheria. He said that "not without 
serious misgivings had he taken up the serum treatment. 
* A burnt child shuns the fire,* " he said, " and from tuber- 
culin I had carried away bad burns." Three years previ- 
ously Behring had tried to induce him to use the serum in 
his clinic, but he had then refused to do so without having 
first seen successful experiments on animals. Behring 
had then experimented on a series of guinea pigs. 
First he injected a LoefHer bacillus culture, and then 
treated a certain number with his serum. The results 
had been the reverse of encouraging; the guinea pigs 
treated with serum all died and the rest recovered. 
Of course, he (Bergmann) had then declined to use the 
serum. What induced him to make a trial of it much 
later was a conversation with Virchow, in the course of 
which the latter gave him the statistics obtained in the 
Kaiser and Kaiserin Frederich Hospital. In view of 
these numbers and similar results in many other clinics, 
he thought it right to continue the trial of the new 
remedy, though a much longer space of time must elapse 
before he could give a final opinion of its therapeutical 

ESSAY. 123 

value. Not many months elapsed before Bergmann's 
reticence, from inexperience, was removed. 

After Von Bergmann, Virchow rose. The purport of 
his remarks showed that treatment by diphtheria anti- 


toxin was begun in March, 1894, in the Kaiser and Kai- 
serin Frederich Hospital. At that time Dr. Aronson 
had placed his serum at the disposal of the hospital — a 
present of the value of about 4,000 marks (;£^20o) — for 
which the hospital owed him sincere thanks. In June 
and July, nearly all diphtheria cases were treated with 
the serum. The results were as follows : 

In the first week, cured 13. Deaths, I child. 







I " 




2 children. 




I child. 




2 children. 




I child. 







Suddenly the supply of serum ceased as, unfortunately^ 
the very horses from which the serum was taken, died. 
The old methods of diphtheria treatment had again to 
be resorted to, and the results were : 

In the first week, cured 5. Deaths, 7 children. 

second ** 6. " 8 " 

" third " 6. ** • 6 

fourth " 8. "II 

fifth " 8. " 5 

sixth '* 8. *• 12 

" seventh " 13. ** 6 

This sad increase in the mortality induced the hospital 
to return to the serum, which was then procured from 
Hochst. Immediately there was a change. 


In the first week, cured 3. Deaths, 2 children. 

** second 

'' fifth 

4. " I child. 

14. " I " 

14. " 2 children. 

17. '* I child. 

17. " 5 children. 

The total figures are as follows : In the whole space 
of time, 533 cases were treated ; 303 with the serum, 230 
without. The former had 13.2 deaths; the latter, 47.8 

Virchow continued that, in view of these results, he 
** held it to be the duty of every doctor to use the serum 
in diphtheria. All theoretical considerations," he added, 
^* must give way to the brute force of these figures." 
He continued that " even if disagreeable by-effects were 
proved to occur here and there, they are not sufficient to 
•dissuade him from continuing the treatment." Turning 
to the theoretical question, he said that ** I consider the 
disease artificially produced in animals by means of the 
Lceffler bacillus has nothing to do, anatomically, with 
Bretonneau's diphtheria. Nor do I consider the bacillus 
as the cause of human diphtheria. A theoretical explan- 
ation of the therapeutic action of the antitoxin serum 
must be left to the future." Thus, Virchow recommends 
the serum, to which he attributes a brilliant therapeutic 
action. At the same time he pronounces the theory 
which forms the basis of Behring's entire antitoxin thera- 
peutics to be a fallacy. Needless to say that his words 
were followed with breathless interest. 

Let me conclude this essay by a quotation from Dr. F. 
Lceffler, Professor of Hygiene in the University of Greif- 
swald, in his ** Report on the Etiology and Prevention of 
Diphtheria," presented on behalf of the German Com- 
mittee to the Eighth International Congress of Hygiene 

ESSAY. 125 

and Demography, at Buda-Pesth. The fifteenth heading 
reads as follows: "One of the most effective means 
against the spread of diphtheria to be cared for is the 
protective inoculation of susceptible individuals in the 
neighborhood of the patient, especially of children. In 
proportion as the inocuousness of the serum treatment 
for the prevention and cure of the disease becomes estab^ 
lished, it becomes important to develop, as far as possible, 
the practice of inoculating it in families and schools in 
which cases of diphtheria have occurred.** 

This is a conservative statement made by the discoverer 
of the diphtheria organism, in his official report to the 
congress assembled at Buda-Pesth, in September, 1894. 

By a singular but timely circumstance, we had no 
sooner finished the foregoing portion of our paper when, 
in the usual course, we received the announcement of 
the stated meeting of the New York Academy of Medi- 
cine, of Thursday evening, May 21, 1896, with the follow- 
ing programme for the discussion of the evening : 

1st. ''Statistics of Diphtheria," by C. G. Coakley, 

2d. '* Clinical Observations on the Antitoxin Treat- 
ment of Diphtheria," and a report of personal investiga- 
tion of this treatment in the principal fever hospitals of 
Europe, during the summer of 1895, by Joseph E. Win- 
ters, M.D. 

3d. " Experiences with the Antitoxin Treatment," by 
P. H. Eriist, M.D. 

4th. " Diphtheria With and Without Antitoxin," by 
W. L. Stowell, M.D. 

Discussion by Drs. Wm. H. Thompson, Geo. L. Pea- 
body, A. A. Smith, John W. Brannan, John Doming, 
A. Caille and others. 

This presentation and review will traverse the subject 


SO completely, between what we have recorded of 1894 
and 1896, and will be published for the benefit of the 
profession, in the medical journals as well as in the 
archives of the Academy, that it will not*be necessary to 
add another word to what we here present as a fully 
demonstrative argument, derived wholly from undisputed 
facts, of the entire adequacy of antitoxin to cure and 
even to prevent diphtheria. 



The Present Status of the Serum Treatment of 


But little attention was given by the profession to the 
subject of diphtheria antitoxin before the meeting of the 
Eighth International Congress of Hygiene and Dermo- 
graphy at Budapest, Hungary, in Septenriber, 1894, when 
Roux presented a paper reporting 500 cases treated with 
antitoxin. Since then the remedy has been extensively 
used and reported upon in every civilized country. 
. Recommended by the great body of laboratory workers, 
endorsed by thousands of physicians, both in hospital 
and private practice, and welcomed by the common sense 
of the people at large, antitoxin has become the most 
widely endorsed and most generally employed of all 
remedies. Though confronted from the first by the 
fiercest opposition, and materially retarded by the un- 
bridled enthusiasm of some of its advocates, diphtheria 
antitoxin has, within the brief period of three years, 
proven itself to be specific in the full sense of that term. 
Emmett Holt, in his new text-book on pediatrics, says: 
** Antitoxin is a specific remedy for experimental diph- 
theria in animals. Experience is now sufficient to justify 
the statement that it is specific in man, and just in the 
degree in which we can fulfil the conditions which are 
essential in experimental diphtheria," (fol. 999). And 


again : ** Gratifying as were the earlier results with the 
serum treatment they have been constantly improving, 
and there is every reason to believe that, with larger ex- 
perience both in the preparation and use of antitoxin, 
still better results will yet be reached. Certainly there is 
no remedy for any disease that has more testimony in its 
favor than has now diphtheria antitoxin," (fol. looo). 

These statements, which are fully endorsed by all the 
leading authorities, it will be noted, were made prior to 
the completion of the rich experience had with the 
remedy last winter, and before the results of the supple- 
mentary collective investigation of the American Pedia- 
tric Association were made known, of which the ** Medi- 
cal News" of May 15, 1897, said, editorially: "There 
can be no longer any doubt as to the value of the anti- 
toxin treatment in all forms of diphtheria. The highest 
commendation should be accorded the American Pedia- 
tric Association for so persistently adding line upon line, 
precept upon precept, until a verdict of proved has been 
established beyond peradventure. The final word has 
been spoken — a fact is before us." 

The above collective investigation showed that under 
antitoxin treatment 73^ of operative cases of laryngeal 
diphtheria recovered, and that only 39^ of cases so treated 
required operation. Under calomel treatment only 2*]% 
recovered, and 90^ of all cases required intubation. 

It is interesting to note how many eminent men in the 
profession and prominent medical magazines, after openly 
opposing antitoxin, or treating it with stolid indifference, 
have joined the ranks of its advocates. Among many 
others, Virchow " yielded to the brute force of figures," 
deeming it ignoble to face facts in brutish obstinacy, and 
Jacobi, who for twenty years has been a leading Ameri- 
can authority on diphtheria, now finds in the failure to 

ESSAY. 129 

employ antitoxin in all cases of diphtheria a heavy shade 
of criminal neglect. The " Medical Record/* comment- 
ing upon the first report of the American Pediatric 
Association, July 4, 1896, said: "The majority of the 
profession may properly continue the use of antitoxin, 
but the great, silent, careful, powerful jury of the pro- 
fession is not yet ready with its final verdict." Com- 
menting upon the second report of the American Pedia- 
tric Association, May 15, 1897, the "Record" said: 
" The report is worthy of close study. Laryngeal diph- 
theria requiring operative interference furnishes the best 
test of the method of treatment. As.the report mentions, 
before the days of antitoxin the best statistics could show 
only 27^ recovery. Other factors remaining constant, 
the use of antitoxin has carried the percentage from 27^ 
recovery up over the divide till it now reads 27^ mor- 
tality, nearly three-fold increase in recoveries." 

The deliberations of the American Medical Association, 
in its recent convention, in Philadelphia, served to show 
how generally antitoxin is employed in the United States. 
The experiences of the last nine months, both in the 
employment of the remedy and the collective study of 
results, have been such, and the evidence in its favor so 
overwhelmingly conclusive, that in a body of medical 
men such as convened at Philadelphia, the physician who 
shows an aversion to the remedy has his motive for 
so doing and his sincerity immediately put in question. 
Every legitimate objection to the remedy is fully over- 
come in the employment of concentrated antitoxin, which 
was introduced during the spring of 1896 by H. K. Mul- 
ford Co., of Philadelphia, and which is now generally 
endorsed. The question to raise is how to employ the 
remedy in order to obtain the largest possible results. 
It is this phase of the present status of the serum treat- 


ment of diphtheria that is of most vital importance. 
The superiority of the antitoxin treatment of diphtheria 
over all other treatments can no longer be reasonably 
questioned, while the methods by which the fullest pos- 
sible specific effects of the remedy may be secured are 
not everywhere well appreciated. The supplementary 
collective investigation showed that many physicians, 
rendered timid by the glaring headlines in yellow journal- 
ism, administered doses having from one-tenth to one- 
half the required number of antitoxic units. The results 
were proportionately unsatisfactory. The indications 
are, that when a reliable product is employed generally 
in proper doses, repeated, if need be, within twelve hours, 
the general mortality from diphtheria will be reduced to 
less than 4^ and that of laryngeal diphtheria to less 
than 10^. 

Regarding the opposition, it has been well said that 
there are today, in the whole civilized world, not more 
than three or four active opponents of the antitoxin 
treatment of diphtheria whose names were known to the 
profession before the introduction of antitoxin. While 
these have raised a great hue and cry, it is well to 
remember that they do not constitute the medical profes- 
sion nor create truth. There can be no virtue in opposi- 
tion which persists in the face of impregnable figures and 
established facts. That the fear of untoward results from 
an injection of antitoxin which some physicians still enter- 
tain is utterly groundless, is a patent fact, in view of the 
•countless injections already made in all parts of the civil- 
ized world, the number aggregating, probably, upwards of 
2,000. In this large number it is admitted that five deaths 
occurred which could not be satisfactorily explained. 
They can not be proven, on the other hand, to have been 
caused by the antitoxin. In all the extensive laboratory 

ESSAY. 1 3 1 

researches, nothing has yet been discovered which could 
possibly or probably contaminate the antitoxic serum and 
result in sudden death when administered. In the five 
cases referred to, in three of which immunizing doses 
were given, untoward symptoms appeared immediately 
upon injection of part or all of the serum and death 
followed in from five to eight minutes. Virile germs, 
ptomaines, etc., even when nurtured in artificial media, 
are not capable of such results in small animals, much 
less in human beings. The cases simply remain un- 
explained for want of sufficient data. The remote cause 
was not recognized and death was incidental to the injec- 
tion, fear, probably, being the exciting cause. 

Sudden deaths have always been a possible outcome of 
the diphtheritic infection, and inasmuch as the severity of 
the infection is not always appreciated, it may be pre- 
sumed that in some of these instances the disease was 
not given the full share of blame. In the three instances 
cited, causes other than the antitoxic serum must be 
sought for satisfactory explanations. In the early days 
of hypodermatic medication, sudden deaths were attri- 
buted to the use of the needle. Even to this day some 
communities will not tolerate the employment of hypo- 
demic syringes. Quinine had its reported fatalities 
when first introduced. The coal tar derivatives, now so 
extensively employed, have been credited with deaths ; 
so have morphine, ether, chloroform, alcohol and many 
other standard remedies. It is questionable whether one 
of these medicaments, within the prescribed doses, has a 
record nearly as clear as that of diphtheria antitoxin, viz., 
more than one million injections and only five deaths 
which, to say the most, cannot be satisfactorily explained. 
If it be conceded that there is an element of risk in the 
employment of antitoxin, this must be placed at one 


two-thousandth of one per cent., while the gain in re- 
coveries ranges from 25 to 30^ over all other treatments. 
If it is possible to give too large a dose of antitoxin, this 
limit has not yet been discovered. Rosenthal has given 
as high as 6,000 units in a single injection. In one case 
which he reported, 15,000 units, and in another, 16,500 
units were administered during the continuance of the 
disease without untoward effects. Every case was fol- 
lowed by recovery. 

Dr. D. G. Sanor, of Malvern, Ohio, reports the case of 
an infant, nine days old, successfully treated with con- 
centrated antitoxin potent, 1,250 units being used within 
24 hours; 500 units 10 A. M., 500 6 P. M.. 250 9 A. M.; 
case grave ; throat and nose full of exudate ; infant began 
to nurse at 2 P. M. 

Within the prescribed range of doses, diphtheria anti- 
toxin may now be administered with the same degree of 
confidence that characterizes our employment of any of 
twenty-five leading therapeutic agents, including quinine, 
morphine, alcohol, strychnine, etc. Idiosyncrasies to 
these drugs are to be expected ; if idiosyncrasies to 
antitoxin exist, they are confined to an occasional urti- 
caria excited by an unripened serum. From the first, as 
the powers and limitations of antitoxin became better 
appreciated, the dose recommended was increased and 
the interval in repetition decreased. As indicated in the 
recent report of the American Pediatric Association, the 
further decrease in the mortality rate from diphtheria 
will depend upon the more general employment of con- 
centrated antitoxins, reasonably early, without fear, and 
in doses of 1,000 or 2,000 units, repeated when need be, 
within ten or twelve hours. The best dosage at present 
recognized is briefly summed up as follows: In all ordi- 
nary cases of pharyngeal type, give 1,000 units immedi- 

ESSAY. 133 

ately upon making the clinical diagnosis. If treatment 
is inaugurated late, or the type be laryngeal, or the case 
be membranous croup, give 2,000 units. In every 
instanpe, if the disease is not arrested or the indications 
are that sufficient antitoxin has not been administered, 
repeat the dose, or give double the dose, within twelve 



Headaches; Auto-Intoxication a Factor. 

In an investigation as to the etiology of headaches, 
one finds himself almost stranded at the beginning by 
the statement of various authors that very little is 
known. To the careful student of this very important 
question I doubt if this paper will develop any new 
points, but I hope to establish the fact that some head- 
aches are due* to auto-intoxication. 

It has been said of the late Robley Dungleson that he 
was a walking encyclopaedia, and at a moment's notice 
could inform you of all the views on a given subject. I 
shall endeavor to follow somewhat his example and give 
you the opinions of several writers in this interesting 

The subject of headache is of obvious importance on 
account of its numerous sufferers, and the frequency 
with which the physician is consulted for its relief, and 
the fact that the head pain oftentimes constitutes the 
first symptom of serious disease. The multitude of 
immediate and remote etiological factors make the path- 
ology obscure. It is impossible to diagnose the nature 
of the headache by a study of the headache itself, and 
the complex nature of the head pain, to a great extent, 
affects exactness in determining its origin. 

Headache is of the most common occurrence and yet 


there is no malady which requires more precise scrutiny 
or makes more demands upon the practical judgment 
of the physician, in throwing light upon its nature and 
making it less obscure. In many disorders of the brain 
you find enfeebled functional activity rather than actual 
pain and suffering. Almost any alteration in the vas- 
cular supply, whether it be degraded or deteriorated, will 
produce irritation, and as a consequence, a disturbance 
in the censorium. 

Of the diseases of the present day, those affecting the 
nervous system are the most typical, and threaten to be 
the diseases of the future. One need not go far to learn 
the causes. The overtaxed condition of the nervous 
system, owing to the requirements of this age, render it 
much more susceptible to disease than during former 
times, and there is a breakdown too early in life, due to 
this extreme nervous tension and lack of rest. The 
rapid pace at which we live has a notable effect to excite 
and exhaust the brain ; the current having started, con- 
tinues with irresistible energy, and the very apt question 
might be asked, " When will this ravage end?** 

Edward Bulwer Lytton thus refers to this in his mis- 
cellaneous prose works in 1868: "The politician, the 
professional man, the merchant, all must experience that 
strain of specikl faculties in the direction towards special 
objects which cause nervous exhaustion, with the mal- 
adies consequent on over-stimulus and prolonged 

Howard is a sound pathologist when he tells us that 
after Prometheus had stolen fire from heaven, a cohort of 
fevers unknown before encamped themselves on earth. 
In our audacious age we are always stealing new fire and 
swelling the cohort of fevers with new recruits. 

Prior to the present advanced state of civilization, the 

ESSAY. 137 

overwrought brain was seldom, if ever, found outside the 
circle of literary men and laborious students of human 
knowledge. Nervous exhaustion was not so frequently 
met with as it is today, and little was said of the causes 
which induced it. In referring to this exhaustion, Sam- 
uel Jackson was accustomed to say in his lectures at the 
University of Pennsylvania, thirty years ago, **When. 
ever the expenditure of nerve force was greater than 
the daily income, physical bankruptcy sooner or later 
results. It must not be forgotten that the nerve assets 
of persons differ almost as widely as do their moneyed 

Nervous exhaustion is not, therefore, so much the 
result of strain which is actually great, as of a strain 
which is exhaustive in its relations to the organism which 
has it to bear. Is it remarkable that the intricate and 
sensitive texture of the brain and nerves should pre- 
maturely give way under this constant strain ? Care and 
anxiety bring additional burdens, and, as a consequence, 
the nervous system is robbed of much of its power of 
resistance, and its susceptibility increased. Then again 
there has been a marked increase of the luxuries of man- 
kind. Indulgence in alcohol produces nervous con- 
ditions by disordering the organs of digestion. The 
human machine may work under high pressure for years 
without giving evidence of wear, but with a majority 
there comes a time when abused nature rebels against 
such treatment. 

The habitual sufferer of headache accepts no other 
form of agony as its equal. A patient said to me, ** I 
would rather endure a severe attack of seasickness a 
week than to suffer one hour with one of my sick head- 
aches." The aching cerebral mass shut up in its bony 
cavity only reveals its condition by the statement of the 


suflFerer. There is no indication whether this or that 
part is the seat of the derangement, and how frequently 
we are left in a quandary whether the origin of the 
trouble is in the brain or some other organ of the body. 

Is there a deficiency of the blood supply to the vessels 
of the dura, or is it in excess ? Is the circulation 
normal ? These are puzzling questions for serious 
thought. Identical symptoms present themselves, when 
conditions diametrically opposite prevail. The wander- 
ings of scarlet and typhoid fevers differ, notwithstanding 
the aspects may be identical. There is the insomnia of 
senemia and congestion. There is the coma of blood- 
lessness as well as plethera. How can we even hope for 
success in the treatment of such perilous conditions if 
we have erred in our diagnosis, or attributed the symp- 
toms to the contents of the brain and general system 
which does not exist ? Pain that emanates from one part 
may be conveyed to a weaker; the nervous susceptibility 
of the patient has largely to do with this. In some 
minds the imagination is so active that even a thought of 
pain would give rise to it. Pain in the knee from hip 
joint diseases, and pain in the lower alveolus from a 
diseased tooth in the upper, are examples of sympathetic 
pain. The sufferer is so positive of the actual existence 
of this reflected pain that the source of the trouble is 
often overlooked. Of the small extra cranial pains, 
little more need be said than that they are manifestly a 
disturbance of the sensory nerves involved. An explan- 
ation of the mechanism of the intra-cranial or brain 
pains is a question of far greater difficulty. 

Apropos of this. Dr. Symonds says : ** Putting aside 
for the present any reference to the patients* feelings, 
what do we learn from anatomical considerations as to 
the probable source of the pain within the cranium. 

ESSAY. 1 39 

when the patient is the subject of headache ? It does 
not appear to be in the nervous matter, whether vesi- 
cular or tubular, of the cerebral hemispheres or of the 
cerebellum. No evidence of feeling has been obtained 
by vivisectors until they approach the sensory ganglia, 
the thalami optici and corpora quadrigemina, but these 
are the centres of sensation to all parts of the body as 
well as of the head. 

"All analogy must, however, look to the nerves as the 
source of pain, though some writers are hardy enough 
to doubt the necessity of nervous matter as instrumental 
in sensation. And what are the nerves? Numerous as 
are the nerves that come out of the cranium, there are, 
on a superficial view, few that go into it. 

"A branch of the sub-occipital accompanies the verte- 
bral artery, but a large majority of the other nerves 
destined for intra-cranial purposes are derived from the 
sympathetic. These then, are the nerves which are of 
general interest to our present inquiry. Nerves of this 
class accompany blood vessels, and when we observe the 
large amount of these vessels, the brain and its mem- 
branes being more liberally supplied with blood than any 
other organ, the quantity being computed as one-fifth of 
the blood of the whole body,. we might, without search- 
ing further, feel convinced that there must be a corres- 
ponding supply of ganglionic nerves, but the minute 
observations of modern anatomists has tracked them in 
iu great abundance." 

Discussing the same point, Niemeyer writes, "The 
headache, a very frequent symptom in all cerebral 
diseases, is very difficult to explain. We do not even 
know if it is of central origin, that is, whether it origin- 
ates in the part of the brain where irritation causes 
symptoms of pain after the insensible greater hemis- 


pheres have been removed, or whether, as I think more 
probable, it depends on the irritation of the filaments of 
the trigeminus going to the dura mater. The great 
sensitiveness to impressions on the senses depends on the 
increase of excitability caused by the cerebral hyperaemia 
or on the hyperaesthesia of those parts of the brain 
through which peripheral irritations are perceived.** 

If the delicate structure of the brain is susceptible to 
disorders from injury, a rational conclusion is that 
the same result would follow functional disorders 
and disturbed nutrition when they have been of 
long standing. The character of the headache varies 
excessively and, unfortunately, in different individuals. 
It is the extra-cranial ; it is intra-cranial ; sometimes an 
intense pain ; sometimes a heavy ache ; then an acute 
throbbing ; now it fills the whole cranium, or settles in 
some one point. It is paroxysmal, or constant, or fixed. 
Let us consider some forms of headache which are 
undoubtedly due to auto-intoxication. 

Bilious Headache. — This very common, though ob- 
scure form of headache, is often designated sympathetic 
or sick-headache because vomiting often dispels the pain 
immediately, the irritation being removed. No head- 
ache, however, should be called bilious unless there is an 
excess of bile that accunriulates in the system, or the 
skin is yellow from its absorption. 

Dyspeptic Headache arises from disease of the 
organs of digestion. Many theories have been advanced 
in explanation of these sympathetic head pains; the 
most generally accepted is that the irritation is felt in 
the brain through the agency of the pneumogastric and 
sympathetic systems. No precise conclusion can be 
drawn from the facts which are proved relating to the 
functions of the par-vagum. 

ESSAY, 141 

Migraine. — Migraine or megrim is one of the most 
frequent forms of headache. The pain is uni-lateral, in 
the great majority of cases affecting more often the left 
side than the right. Its origin is supposed by some 
authorities to reside in the optic thalami, and the visual 
defects to originate in the organ of the affected side. 
One of the supposed causes of this disorder is heredity. 
Not unfrequently is it associated with epilepsy. There 
are cases in which the two forms of paroxysms seem to 
replace each other. However, it is doubtful whether 
any connection exists between the ordinary migraine and 
the more serious disorder. Many theories have been 
advanced explanatory of the attack, but they still remain 
theories. The clinical experience of some authors seems 
to demonstrate that migraine is in some way related to 
gout. Secondly, that the great majority of cases are 
inherited, which has close relation with other serious 
neurotic ailments. Disordered cerebral circulation, the 
exciting cause of which is vaso-motor disturbance, is 
undoubtedly a factor in migraine. This condition has 
been ascribed to uric acid, but is probably a manifesta- 
tion of leucomain poisoning. 

T0X.EMIC Headache. — Under this category may be 
included the forms of head pain due to a chemical 
change in the constitution of the blood, and the reten- 
tion of various toxic substances introduced into the 
system from without, or evolved through the agency of 
some organic or functional derangement. The most 
important varieties of toxaemic headache are uraemic, 
malarial, rheumatic, gouty, diabetic, alcoholic and the 
headaches of fever. 

Febrile Headache. — In acute fevers, headache is 
almost invariably present, due to an abnormal quantity 
of blood in the brain. If the patient is strong and 


robust, the hyperaemia is greater. Headache is very 
frequent in pneumonia, bronchitis and the various exam- 
themata. With the absorption of the febrile poison, 
every tissue through which the blood flows is impressed 
by it, and one of the most certain indications is headache. 
In typhoid it is a prominent symptom, the pain fre- 
quently resembling that of typhus, in character and 

Uremic Headache. — This is a familiar form; the 
combined symptoms of kidney disease generally makes 
diagnosis clear, and the pain is largely controlled by the 
condition and the amount of the urine, and the quantity 
of it and excrementitious matter voided. Headache is 
frequently an early warning of serious renal trouble. 

The characteristic Malarial Headache almost in- 
variably takes the form of so-called " brow-ague." It 
appears at somewhat regular intervals, often of frightful 
intensity, lasting from five to ten hours, and may or may 
not be accompanied with fever and sweat, or other 
malarial indications. 

LiTHiEMic OR Gouty Headache.— The dull, heavy 

headache, worse in the morning, although it may occur 
in acute paroxysms at irregular intervals, associated at 
times with loss of consciousness, which resembles petit- 
mal, leading to a diagnosis of organic lesion of the brain. 
Ultimately the small joints, and some of the large, are 
attacked with a violent gout, with deposits, and per- 
manent disability. 

I am indebted to my friend. Dr. Rogers, of Woodbury, 
for the bacteriological aspects of this question, for ex- 
tracts from his translation of Mace's bacteriology. 

Let us consider for a few moments, certain forms of 
bacteria. Pasteur describes two species which he calls 
aerobics, which depend largely upon oxygen for their 

ESSAY. 143 


development, and others, which seem to be destroyed by 
the presence of oxygen, he terms anaerobics. He 
demonstrated that liquid undergoing lactic fermentation 
after a time contains thick, short batonnets of the 
bacillus lacticus ; this species is aerobic. The liquid is 
markedly disturbed, until all the oxygen is disengaged, 
at which time the cells fall into a latent state and 
cumulate at the bottom of the liquid. Then the second 
species seem to develop anaerobic, which do not require 
oxygen for their development; this is the bacillus butri- 
cus ; entirely different from the bacillus lacticus, its 
batonnets being longer and of proportionately greater 

The phenomena which they cause in their medium are 
altogether sui-generis ; their action gives rise to an active 
evolution of gas. Microscopic examination shows a 
reversal of the conditions observed with the aerobic 
bacillus; the conditions necessary to the life of the one 
cause the death of the other. The batonnets avoid 
those places where they may be attacked by the air. If 
subjected to its influence their movements cease and pass 
into a latent condition or die. Vitality is possible only 
at the centres of the culture where the oxygen is not 

What is the explanation of these facts that seem so 
abnormal ? According to the fine researches of Pasteur, 
there is an intimate connection between this airless life 
and fermentation. 

The bond between vitality that it must have and 
vitality destroyed by air, is carbonic acid. There un- 
doubtedly exists a series of intermediate changes, the 
further consideration of which will undoubtedly throw 
great light upon anaerobic organisms. It seems a reason- 
able conclusion that if the cells of the anaerobic species 


are sensitive to the action of oxygen, their pores are 
also. These may withstand the contact with air for long 
periods without suffering harm. It may be that this con- 
tact is necessary for their development. This would seem 
to indicate that there is a strong bond between the aerobic 
and anaerobic. The spore cannot develop in a nutritive 
medium in the absence of oxygen. Between these 
species whose development is checked with the least 
trace of oxygen, and those having an absolute need 
of it, we observe numerous other species which are, in 
this regard, utterly indifferent and appear to be in a tran- 
sitional state; the first are true anaerobics, the last 
are the optional anaerobics. They grow somewhat more 
rapidly in the air, but grow also in media entirely 
deprived of oxygen. All living cells should find in the 
medium in which they are envolved, the material to 
compensate them for their loss in vital action, and also to 
add to their substance for actual or reserve needs ; this 
must, of necessity, include those simple substances which, 
under various headings, go to form the living cell. So it 
is with the bacteria as with all the living beings. The 
principal source of nutrition is the group of albuminoids, 
and the most serviceable of these are those which are 
soluble and diffusible ; this is the condition of the pep- 
tones. Many species of bacteria have the power of trans- 
forming albuminoids into peptones. This power so 
necessary to digestion is due to the secretion of the 
special ferments, of which the production is in such 
direct ratio to the nutritive requirements that they are 
only formed by the cells as they become necessary. 

Some cells which produce a considerable quantity of 
active ferment, when nourished on albumen, envolve but 
a trace on a diet of peptones. Urea is a good source of 
nitrogen ; the nitrates, especially those of potassa and 

ESSAY. 145 

soda, serve also for nitrogenous nutrition, but it is neces- 
sary that they be accompanied by other organic matter. 

The bacteria need also many mineral substances which 
we recover from their ashes, such as sulphur, potassium, 
calcium, magnesium and iron. The importance of the 
albuminoids and the turnery matters which enter into 
the vital current in a determinate manner, after having 
undergone known modifications, is entirely a matter of 
conjecture. It is not so with the mineral substances. 

Raulin's researches, in the development of the asper- 
gillus-niger. illustrates admirably this condition. This 
fungus develops abundantly on slices of lemon, on bread 
soaked in vinegar. Raulin gives a formulae of a mineral 
medium in which the condition of time, light, tempera- 
ture and aeration being equal, the crop of the plant is 
greater in weight than that grown on any neutral soil of 
culture. Raulin's liquid consists of water, sugar, candy, 
tartaric acid, nitrate of ammonia, phosphate of ammonia, 
carbonate of potash, carbonate of magnesium, sulphate of 
ammonia, sulphate of zinc, sulphate of iron, and silicate 
of potash. If there is a diminution or omission of one of 
these salts, those whose quantity is small, the growth of 
the fungus becomes greatly lessened. In a liquid con- 
taining no potash, the loss of growth is one twenty-fifth ; 
if the zinc is absent, one tenth; without ammonia it 
loses one one-hundred-and-fiftieth. While the effect of 
these mineral agents is indisputable, the r61e they play in 
the vital action is unknown. The albumens, to become 
absorbable, need first to undergo complex changes which 
are not well understood ; they become soluble and change 
with hydration into dialysable products not coagulated by 
heat. These are given the name of peptones. They are 
present in a marked degree in the species causing putre- 
faction. Putrefaction in this case depends upon peptonic 


zation, with the production of the phenomena of 
putridity, characterized always by the evolution of gases. 
This peptonization is due in all cases to the action of the 
diastase secreted by the bacteria. Soluble ferments have 
been isolated which resemble pepsin in their action. 

Selmi obtained from human cadavers, products of 
excretion, nitrogenous bases dosely allied to the vegetable 
alkaloids having in many respects the same chemical and 
physiological action. These he called ptomaines. 

Gauthier has made an exhaustive chemical study of 
their relations to putrefaction and development of 
bacteria. Some have a very faint effect on the animal 
economy, others are very pronounced, frequently pro- 
ducing death in minute doses. These are comparable to 
the most energetic poisons, as morphia and atropia, the 
diseased conditions arising from these products of 
pathogenic bacteria producing symptoms identical with 
the infectious diseases in which they are found. 

Bouchard has obtained from the urine of patients 
suffering from infectious diseases, quantities of ptomaines 
which he is positive proceed from the development in the 
organism of the pathogenic bacteria which are the cause 
of the disease. Breg6r has found in the culture of the 
bacillus of typhoid a ptomaine which he considers a 
triamin having a toxic action. 

Let us consider the residues of putrefaction. Owing 
to certain conditions, they may be ammoniacal com- 
pounds, fatty volatile acids, or products of penetrating 
fecal odor, as indol or scatol. Gaseous hydrogen is 
frequently produced, which, coming in contact with 
sulphur and phosphorus in the albuminoids present, pro- 
duce either sulphuretted or phosphoretted hydrogen, 
forming a repulsive putrefactive odor. Besides these 
volatile products, we find fixed residues, like the vital 

ESSAY. 147 

activities of bacteria. These are leucine, tyrosin, glycocol 
and the various ptomaines. The species causing putre- 
faction are numerous, and for the most part but little 
known. The action of certain species on the medium in 
which they live, in the course of their development, pro- 
duce at the expense of the medium, important modifi- 
cations. The aliment passes into the cells, where it is 
transformed into simple molecules ; it is then ejected to 
without, where the residue accumulates. This is called 
fermentation. It is difficult to separate fermentation 
from putrefaction. The distinction is based on the 
quality of the resulting product, i. e,, a germ is a bacteria 
fermentation when the result of its activity is a useful 
product. Putrefactive species lack this. The reactions 
which form the bases of the fermentations vary accord- 
ing to the species of the bacteria, and also according to their 
nutritive needs. Certain species require the presence of 
an abundance of oxygen to produce fermentation. 
These are the ferments by oxidation. In other species, 
oxygen is not only unnecessary, but noxious, producing 
nascent hydrogen, which acts as a reducing agent. 
These represent the ferments by reduction. The third 
classification, fermentation by division, the reaction is 
quite simple, the molecule of the initial product is 
divided, giving two to the new product. 

We may connect with the fermentations, the solution 
of albuminoid matters by those species having the power 
of turning albuminoids into peptones. Numerous bac- 
teria are a factor in these transformations, only a few of 
which are known. The bacillus lacticus secretes a rennet 
which coagulates the casein of the milk, a process neces- 
sary to its ulterior transformation ; it also furnishes a 
special diastase which changes the lactose into maltose, 
by the process of hydration, thus fitting it to undergo 


the alcoholic fermentation through the action of the 
yeast. In this phenomena the action produced by the 
living ferment is out of all proportion to its weight, a 
small quantity of ferment transforming a large amount of 
fermentable matter. 

Du Claux calculated that a single bacteria of vinegar 
destroyed in twenty-four hours, fifty to one hundred 
times its weight in alcohol, and this is an essential char- 
acteristic of the ferments. 

The medical science, after having devoted generations 
to the study of anatomical lesions, pathological con- 
ditions, and the symptoms of disease, takes up at last 
the most important feature, the origin. 

A characteristic of our times is the rapid acquisition 
of accurate knowledge; the dream of yesterday is the 
possibility of today and the realization of tomorrow, and 
a consequence of this is found in an ever changing base, 
so that in the case of this subject matter of auto- 
intoxication, our point of view is now so different to 
what it was when the name was coined that it has lost 
some of its true meaning; indeed, if we define it as a 
condition of poisoning, produced by the patient's own 
products of retrograde metamorphoses, it has lost its 
significance to the modern pathologist. 

Let us take a simple example of poisoning by hydro- 
gen sulphide. If I am exposed to an atmosphere 
contaminated with this gas, ingest meat, in that incipient 
state of decomposition, when this gas is given off in 
sufficient quantity to blacken a silver fork with which 
the meat is eaten, or absorbed through my own gastro- 
intestinal tract, the gas produced either by the action of a 
microbe or a chemical decomposition into which the 
microbe does not enter, the symptoms will be similar. I 
shall probably have headache, depression, foetid diar- 

ESSAY. 149 

rhoea ; but, save in the last case, I am not suffering from 
a true auto-infection. 

In the first two examples the poison has plainly been 
introduced from without ; in the third it has been manu- 
factured by an indweller in my economy, i, ^., a product 
of physiological activity, intended for excretion, if not 
eliminated, is considered an auto-intoxicant as well as one 
reabsorbed after being excreted, and that these products 
of excretion may touch foreign matter on the surfaces of 
the excretory organs, forming injurious compounds 
which are again absorbed ; and it will be understood that 
I use this term of auto-intoxication as a convenient one, 
to designate certain fairly well defined conditions, with a 
full appreciation of the fact that the role of the external 
world, and of chemical reactions within, brought about 
by microbic action, are so inextricably mixed that the 
term is largely useful as a label. 

Bouchard lays down four general pathogenic processes 
which induce disease: first, primary elementary dystro- 
phis; second, nerve reaction ; third, disorders antecedent 
to nutrition, and fourth, infection. He claims the first is 
due to a vital activity of the cells, which is produced by 
some cause, physical, mechanical or chemical, either the 
sudden shock of intoxication or of traumatism. 

Physiologists have long told us of the marked action 
of the nervous system in the production of disease condi- 
tions. It is questionable whether we have given the 
reflexes a pathogenic influence greater than they possess. 
We know frequently that mental fatigue, headaches and 
physical disturbances are largely due to pathogenic 
influences upon the nerve centres. Disturbances ante- 
cedent to nutrition are undoubtedly the cause of many 
diseases, of both a chronic and acute form. 

Bouchard claims that diathesis is a prominent disturb- 


ance of nutrition, which prepares and maintains different 
diseases, as seen in their location, evolution and pathologi- 
cal processes. Diathesis may be developed by nerve re- 
action by disturbing nutrition, which must be weakened 
before a person is susceptible to nerve shock. Pathogenic 
influence of nerve reaction caused by nutritive derange- 
ment aids in the development of microbes. While we 
are well satisfied that many diseases are produced by 
microbes, and that these act by deterioration of health, 
growing out of various pathogenic processes, the organ- 
ism must be sustained and defended, guided by this 
axiom : ** every illness is preceded by disturbance in life, 
for nutrition is life." 

Infection, almost as old as the founder of medicine, 
has only assumed its proper sphere within the last gener- 
ation. Since all putrefaction is due to the action of 
bacteria, it follows that all ptomaines result from the 
growth of these micro-organisms. The kind of ptomaine 
formed will depend upon the individual bacterium 
engaged in this production, the nature of the material 
acted upon and the conditions under which the putre- 
faction goes on, as temperature, amount of oxygen, and 
the duration of the process. Without doubt, many of 
the secondary products of putrefaction arise from reactions 
between antecedent and more complex products, and 
are purely chemic. The micro-organisms may be poisonous 
or the poisons may be an integral part of them. Infec- 
tious disorders are largely swayed by the disintegration 
of numerous bacteria cells and the introduction of these 
poisons into the circulation. We know positively that 
specific toxins are generated within the bacterial cells 
and that specific pathogenic micro-organisms, when 
admitted into the system with favorable conditions, 
increase and elaborate a chemic poison which induces 
characteristic results. 

ESSAY. 1 5 I 

Said results are, by virtue of the chemic, toxins. The 
channels of infection in the human organism are the 
vascular and lymphatic systems, the alimentary canal 
and cellular tissue. The alimentary canal furnishes the 
best source of auto-infection. The fact is easily ex- 
plained ; man is constantly taking into his stomach ill- 
chosen food and drink. Even with this ill treatment he 
might escape if peristalsis were sufficiently active, but 
upon continued indulgence the stomach refuses to pro- 
test, the muscular coat of the intestines weaken when 
these conditions become fixed, there is a continual 
absorption of the toxic and infectious matter from the 
intestinal tract. 

Persons in perfect health are not susceptible to infec- 
tion, but when their health is broken by disordered 
nutrition, they become fit subjects for the development 
of microbes. Infection becomes possible by a changed 
condition of the system antecedent to nutrition. 

The nerve elements are most frequently affected by 
causes inducing alterations; nutrition is disturbed when 
there is a reaction of a disordered nervous system. This 
leads easily to infection and opens the way for germs 
ever present which, destined to destroy dead matter, may 
also destroy living matter, when the surroundings are 

Nerve reaction of itself could not create infection ; it 
renders infection possible by weakening' the healthy 
organisms. The body in its normal, as in its .pathological 
state, is a receptacle and a laboratory of toxic substances. 
Some are produced by the organism itself, others by 
microbes. The first in importance ate the mineral 
substances taken with our food ; then comes the product 
of physiological secretion, saliva and bile, the products of 
digestion and those formed by intestinal putrefaction. 


Undoubtedly the stools eliminate the largest portion of 
these poisons, which are expelled with them^ but many 
of them are absorbed, due to the slow movement of the 
intestinal contents. 

The skin and lungs are active in expelling these poisons, 
but the kidney is unquestionably the most important 
channel of excretion, and cannot be charged as a defec- 
tive excretory organ capable of reabsorbing what it 
eliminates. The liver acts as a protective agent by 
arresting the poisons before they are taken into the 
circulation, either neutralizing them or throwing them 
into the intestines where they are either expelled or 
converted into a foecal mass, which does not allow absorp- 

The protective action of the blood is remarkable. 
There is nothing in physiology which Warrants us in 
accepting the alkaloids found in the urine as products 
elaborated by the kidneys ; the logical conclusion will be 
that the blood is a necessary medium between the seat 
of formation and their place of elimination. Hoffmeister 
tells us the white globules play a part in the transform- 
ation of peptones into albumen, since the peptones in- 
jected into the blood are no longer found in the excretory 
organs. Perhaps this hypothesis could be applied to the 
destruction of poisons; thus, the toxic substances, coming 
from the intestinal canal, are neutralized in the blood by 
the white globules. 

Haig, in his work, "Uric Acid as a Factor in the 
Causation of Disease," claims that certain forms of head- 
ache are due to the excess of uric acid in the blood, and 
that we frequently see conditions simulating epilepsy by 
the action of uric acid upon the nerve centres, and that 
with the rapid elimination of uric acid, the blood is 
relieved of this excess and the symptoms subside. 

ESSAY. 153 

Bouchard injected, experimentally, into the blood, 
thirty centigrammes of uric acid for each kilogramme of 
the animal, without accident. Once he injected sixty- 
four centigrammes for each kilogramme, without injury. 
When death occurred he was convinced that it was due 
entirely to the excess of the vehicle. 

Roberts says that uric acid and its compounds are 
deleterious, simply because of their sparing solubility in 
the bodily media. 

Ratchford claims that in a careful and exhaustive 
study of uric acid cases, the etiologic factors in prO: 
ducing the nervous symptoms generally attributed to 
uric acid, that the uric acid leucomains, of which parax- 
anthine, the most poisonous, are very important. He 
claims that it is apparent that migraine, frequently fol- 
lowed by a form of epilepsy having as its most import- 
ant etiological factor the poisonous leucomain, paraxan- 
thine must, of itself, be a form of leucomain poisoning, 
and that uric acid poisoning, as a cause of nervous dis- 
orders, has never been confirmed by either a chemical or 
physiological experiment. 

Many disease conditions necessitate some such theory,, 
which is altogether so convenient that we do not care to 
drop it. Experiments have demonstrated that uric acid 
is not poisonous, and that disease is produced by its 
insolubility in the body media, and simply in a reflex 
manner. Certainly we are forced to discard entirely the 
belief in the power of uric acid to produce nervous 

Migraine and its sequela of nervous disorders so painful 
are hard to manage as to origin and treatment. Careful 
investigations show that kidneys excrete paraxanthine 
and xanthine in excessive quantities, while suffering 
from migraine or migraneous epilepsy. If these poisons 


are not found in excess in urine between attacks, would 
it be an overdrawn conclusion to say that migraine has 
its origin in leucomain poisoning ? 

Let us for a time consider the leucomains. They are 
the products of retrograde decomposition of animal 
tissue, and include all basic substances formed in animal 
tissue during normal life, in contradistinction to the 
ptomaines or basic products of putrefaction. Of these 
we will consider the leucomains of the uric acid group^ 
closely related to uric acid, of which paraxanthine and 
xanthine are poisonous. 

Salomon, who has isolated paraxanthine, thus describes 
its physiologic actions : In mice the reflexes are increased 
to a tetanus, followed by a rigor mortis-like contraction 
of the muscles, and dyspnea is a constant symptom. The 
formulae for paraxanthine is C-7, H-S, N-4, O-2. 

Paraxanthine has two atoms of oxygen, while uric acid 
has three. The method of obtaining paraxanthine is 
long and complex, but the chemical test can easily be 
made ; a few drops of the suspected liquid are mixed 
with a little chlorine water containing a trace of nitric 
acid, and evaporated ; when dry, they are exposed to an 
ammoniacal atmosphere; if paraxanthine is present, a 
beautiful rose red color is produced. 

Migrainous epilepsy, a disease that comes on during 
middle liife, as a sequel of migrainous headache, is 
undoubtedly another manifestation of leucomain poison- 
ing. Attacks are different from true epilepsy, and 
seldom leave an impression upon the brain. Investiga- 
tions would seem to indicate that these attacks are 
brought on by an excess of paraxanthine and other poisorr- 
ous luecomains in the blood. It would seem reasonable to 
conclude that migrainous epilepsy is closely allied to 
migraine, and that this condition is produced by an over 

ESSAY. 155 

production rather than a deficient elimination of paraxan- 
thine. The characteristic symptoms of paraxanthine 
poisoning are headache, epileptoid convulsions and 

While it seems to be a generally accepted fact that 
gout is due to auto-intoxication, owing to a want of balance 
between the process of absorption, metabolism and excre- 
tion, Ratchford claims that the close similarity between 
the nervous symptoms of gout and chronic lead poison- 
ing, each of which has almost the same pathological 
anatomy, that the factor, leucomain poisoning, which 
these two pathological conditions have in common, 
has something to do with the structural changes as well 
as the nervous symptoms which occur in these diseases. 
He seems to have established conclusively that these 
toxaemic conditions of gout and lead poisoning are 
largely due to paraxanthine. 

Naunym has called our attention to the marked 
resemblance of the nervous and psychical symptoms in lead 
poisoning and chronic alcoholism, and suggests that lead, 
like alcohol, produces these effects, not as a direct poison, 
but indirectly as a consequence of abnormal nutrition and 
deficient elimination of the system, brought about by 
the continued circulation of a foreign poisonous material 
in the blood. 

Ratchford has proved that in both these conditions 
paraxanthine is present in excessive quantities in urine. 
He is firmly convinced that in the symptom complex, 
which we call uraemia, paraxanthine poisoning is an im- 
portant factor, and lays down certain statements in sub- 
stantiation. First, paraxanthine poisoning in the mouse 
is characterized by a reflex excitability which is followed 
by stupor, dyspnea and convulsions. The convulsions 
in the beginning are clonic, then become tetanic ; that 


paraxan thine is an important factor in producing head- 
ache, gastric pain and irritation, and convulsions. The 
most characteristic symptoms of uraemia are headache, 
gastric irritation, stupor and convulsions. 

By a careful examination of the blood in uraemic 
patients, in the stage of stupor, paraxanthine has been 
discovered, which gives a physiological reaction when 
injected into mice ; further, that paraxanthine does not 
exist in normal blood, neither is it found in the blood of 
patients dying from other diseases. With these facts, 
the conclusion is drawn that paraxanthine is the import- 
ant factor in producing uraemia. 

He also reasons that as paraxanthine is deficient in 
oxygen, a substance having an oxidizing property would 
act as an antidote in paraxanthine poisoning. In 
mice which had had a poisonous dose of paraxanthine, 
he injected a one per cent, solution of potassium perman- 
ganate ; the characteristic symptoms of paraxanthine 
poisoning were not present, and the mice recovered. 
From his researches and from my own cases, I am con- 
vinced that the leucomain, paraxanthine, is largely a 
factor in migraine and toxaemic headache. 

Case /. — Miss H., single, age 54, weight 165 pounds, 
of sedentary habits, very fond of rich food, chronic suf- 
ferer from catarrhal jaundice, headache constant, dull at 
times, throbbing in character, augmented with dizziness 
(objects moving to the left). Immediately preceding 
acute exaccerbations of jaundice the pain would become 
of a lancinating character; bowels pasty, constipated, 
pale (not clay color); urine flooded with bile pigments, 
intensely acid, scalding when passed. Examination of 
eyes, kidneys, heart and abdomen negative, excepting 
localized, tenderness over gall duct. Patient would be 
somewhat relieved by large doses of phosphate of soda. 

ESSAY, 157 

followed by brisk saline purgatives, but only for a time. 
Last winter, patient had severe attack of hepatic colic, 
passed three gall stones, and has since been practically 
free of headache. Undoubtedly the dilatation of gall 
sacks, due to obstruction of stones, with retention fol- 
lowed by absorption of bile, was the direct cause of the 
constant headaches in this case. 

Case 2, — Mrs. B., married, age 30. chronic sufferer from 
gastro-intestinal dyspepsia, with violent attacks of head- 
aqhe ; has gone the round of Philadelphia hospitals and 
visited numerous physicians, with one result — no relief. 
Headache is frontal, constant, dull and heavy in char- 
acter, decidedly worse after taking food of any kind ; 
vertigo marked, eye grounds normal, urine negative, 
bowels irregular and inclined to diarrhoea, fetid ferment- 
ing discharges when moved ; constant eructation of 
gas, large quantities passed from bowels; palpitation 
of heart, with occasional attack of hiccough ; move- 
ments of gas from the bowels audible throughout the 
room. Careful attention to diet and treatment does not 
seem to afford the slightest relief. No medication seems 
to control the fermentation. 

Case J. — Headache due to septic infection from pus 
tubes. Mrs. F., married, age 36, weight 113, headache 
constant in character, localized in temporal regions, dull, 
throbbing pains, associated with marked disorder of 
vision, worse upon exertion, sense of weight at pit of 
abdomen. Examination of eyes and urine negative, bow- 
els regular, appetite and digestion good. Date of trouble 
from an abortion which occurred six years prior to pres- 
ent examination. Upon examination of abdomen and 
genitalia, severe laceration of perineum was only lesion 
found. This was immediately repaired, and while 
patient was under ether, a more careful examination 


detected a small pus tube in left side, but her condition 
at time of operation was bad, necessitating postpone- 
ment. Made good recovery, but headache continued; 
in fact, grew worse in spite of treatment, and 
now developed symptoms of sepsis, loss of weight, 
appetite and strength failing, and pains in head were 
now distinctly dull and throbbing in character, and not 
so thoroughly localized; abdominal pains were , pro- 
nounced, with acute exaccerbations immediately preced- 
ing menstrual periods, with profuse vaginal discharges of 
pus and blood. Examination showed decided increase 
of tube in left side, also, involvement of right tube. 
Removal of tubes followed, which only contained about 
four ounces of fetid creamy pus. The patient recovered 
very slowly, showing intense septic infection, but careful 
attention to eliminative functions, tonics, etc., finally 
brought her in good condition. Headaches have ceased 
entirely ; relief was gradual, not sudden, and apparently, 
improvement depended upon activity of the bowels, 
kidneys and skin. At the present time does not know 
what headache means. 

Case 4., — A. T., age 19, typhoid fever of six weeks' 
duration ; apparently seemed to be on the high road to 
recovery, as there had been an entire cessation of fever 
for eight days, bowels gradually assuming a natural 
appearance ; was suddenly taken with a severe headache 
on right side of head, largely frontal in character. Delir- 
ium gradually came on and in six hours from the onset 
of the headache the temperature had risen to 105. There 
was the usual morning remission and evening exaccerba- 
tion for ten days, during which time, when at all rational, 
complained of a severe headache on right side. A 
marked symptom of this case was jaundice, affecting the 
right side of the body, and examination revealed the 

ESSAY. 159 

presence of indican and bilirubin. In this case there 
were three distinct relapses, after an intermission of from 
eight to ten days between each relapse. The recurring 
attacks were always preceded by severe headache upon 
the right side, followed by a marked increase in tempera- 
ture and jaundice. The patient made a gradual recovery 
and has seemed to be in excellent health ever since. 
Were these relapses the result of auto-infection, or accord- 
ing to the latest French idea, due to a retention of the 
typhoid bacillus in the gall bladder? 

Case $. — Mrs. G., age 55, weight 160, had been a 
sufferer from severe attacks of headache on right side 
and top of head for years; occasionally under these 
attacks would become unconscious. When she first came 
under my notice, examination detected a murmur at apex 
of heart, pulse on left side extremely weak, tongue 
covered with a thick, yellowish-white coating, bowels con- 
stipated and urine negative. She informed me that these 
attacks has been rapidly growing worse, and shortly after 
becoming my patient had the first spasm. The spasm 
was of a clonic tetanic character and lasted twenty min- 
utes. A careful regulation of her diet, with a partially 
successful attempt to get her bowels into better condition, 
seemed to improve her general condition and for a time 
the attacks were not so severe, but every four or five weeks 
she would have one or two of these spasms, of more or 
less severity. 

Having had my attention attracted to the experiments 
of Dr. Ratchford, I had a very careful examination made 
of the urine, in which paraxanthine was present in excess. 
The chemist who made the analysis for me, experimented 
with mice and reported that a half milogramme produced 
the symptoms of paraxanthine poisoning, with death. 
In this case, following the suggestions of Dr. Ratchford, 


permanganate of potash, with inhalations of oxygen, has 
been of marked benefit. In connection with marked 
attention to the enunciatories, the attacks are not so 
frequent and less severe. 

Case 6, — Mrs. N., age 30. Several in the family have 
migraine. She has suffered with it since childhood. The 
attacks vary from two to six weeks ; if the attacks are 
very severe, the period of immunity will be longer. 
Mild attacks frequently occur every week with regularity, 
then a severe attack and quite a period of cessation. 
Almost invariably an attack at menstrual period. The 
attack is preceded by a burning sensation in one cheek, 
accompanied by a dilitation of the blood vessels of the 
cheeks, then follows the severe headache, nausea, vomit- 
ing, and prostration. Urine contains an excess of uric 
acid and a lessened quantity of urea. Paraxanthine in 
increased quantities gave the same physiological action 
on mice. 

Case 7. — Mr. K., age 45, has a curious history. He is 
able to attend to his work for a period of several weeks, 
then suddenly becomes melancholy and irritable. Has 
almost constant headache, accompanied with nausea, and 
the least exertion tires him. Has a heavy, oppressed 
feeling in the stomach, cannot sleep, feet and hands cold 
and loss of appetite. Conjunctiva sh'ghtly yellow, and 
yellow spots appearing on the body, particularly on the 
chest, abdomen and forehead : bowels constipated, urine 
diminished in quantity and urea reduced, and bilirubin 
and indican are present. Carter has demonstrated that 
this last substance is undoubtedly due to a retention 
within the intestines of foecal matter. 

Case 8, — L. H., age 15, has been a sufferer from head- 
ache, migraine in character, for five years. Her menstrual 
periods began when she was but eleven years old. At 

ESSAY. l6l 

that time the attacks were more severe, coming at inter- 
vals of every two weeks, and the attacks coming at the 
time of her periods were of more severity than those in 
the interim. After one year there was a slight loss of 
consciousness, which gradually increased and was followed 
by spasms, first of a hysterical type and later of a clonic 
tetanic character. The attacks were generally preceded 
by a flushing of the face, tingling sensation in the cheeks 
and ear of left side, then the headache of more or less 
severity, followed by the spasm, lasting from fifteen to 
forty-five minutes. Consciousness returned slowly and 
always accompanied by vomiting ; patient would be more 
or less confused for some time. For two or three hours 
after attack, when roused, would complain of pain in the 
left shoulder and arm. During the attacks her lips, under 
eye-lids and finger nails would be quite blue, breathing 
labored, pulse 95 at the beginning and increasing to 130. 
Her condition would become normal in from three to 
four hours; bowels constipated and urine contained 
paraxanthine and xanthine in large quantities. A full 
grown rat, into which was injected four minims of a con- 
centrated solution, gave all the physiological symptoms 
of paraxanthine poisoning ; it became very nervous and 
jumped from side to side of the box, then clonic tetanic 
spasms followed by a relaxation of the muscles and hard,, 
gasping breathing; marked convulsive movements, and 
death in sixty-three minutes. This patient has been tak- 
ing permanganate of potash for the past two months 
and is somewhat improved, the attacks being less severe 
than formerlv. 

I shall not attempt to analyze these cases that I have 

presented to you, but I am firmly convinced that the 

conclusion can be drawn that, clinically considered, the 

intoxication develops a line of symptoms largely refer* 


t62 medical society of new jersey. 

able to functionable disturbances of the nervous system. 
It may have occurred to you that I have laid altogether 
too much stress upon the question of bacteriology in 
connection with this matter of auto-intoxication, but I 
am fully satisfied that it is almost impossible to differenti- 
ate between the r61es of auto and microbic intoxication, 
as at every stage in the process of digestion, their action 
must be intercurrent. It would be difficult to conceive of 
an intoxication due absolutely either to the patient's own 
waste or the by-products of the microbes. Cadeac very 
plainly states this in his work on pathology. *' The 
patient suffering from an infectious disease must support 
at the same time, not only the effects of his own waste 
products, but also those much more dangerous, of the 
microbe that he harbors.** 

The intimate relationship between certain forms of 
bacteria and chemic poisoning, due to the absence of 
oxygen, is interesting. Vaughan tells us that an infec-* 
tious disease arises when a specific pathogenic micro- 
organism, having gained admittance to the body, the 
conditions favorable, grows and multiplies, elaborating a 
chemic poison that induces characteristic results. In 
speaking further about the origin of these chemic poisons, 
he claims that the metabolic changes, by which the com- 
plex organic molecule is split up into simpler compounds, 
are the source ; that this cleaving or breaking is contin- 
ued by the action of certain poisons, and that the products 
are urea, ammonia, water and carbon di-oxide, and that 
there are intermediate products which are highly poison- 
ous. From the intensely poisonous character of some of 
the leucomains, it follows that chemical composition is an 
indication of physiological action. " It matters not 
-whether the proteid molecule be broken up by organized 
ferments, bacteria, or by the unorganized ferments of the 

ESSAY. 163 

digestive juices, by the cells of the liver, or by those still 
unknown agencies which induce metabolic changes ; in all 
the tissues, in all cases, poisons may be formed.'* 

There is no doubt but that Sternberg, Vaughan, Bouch- 
ard and Gautehier are upon the right track to fathom 
this question of the origin of disease, but much remains 
yet to be done. A careful chemical study of all forms 
of bacteria is necessary to discover which is poisonous ; 
also, under what conditions these disease germs are 
poisonous. Bacteria cultivated on dead material, out- 
side of the organism, are not likely to produce the same 
chemic poisons when developed under the susceptibility 
of the various secretions. Care must be taken of the 
chemic properties and the physiological action of these 
poisons. The effect of these toxins on the brain, spinal 
cord, heart and gastro-intestinal tracts must be carefully 
considered ; until this is accomplished, we must remain 
ignorant of the origin of the disease, and so long as we 
do, how can we expect to successfully combat with it. 
Patience, exhaustive study and experimental research 
alone can decide this momentous question. 

It is evident that medicine which has roved for centur- 
ies through the slough of empiricism after various 
phantoms, is at last on the right track which leads to the 
detection of the origin of the disease, to its removal and 

I wish to express my thanks to Dr. James Hunter, of 
my o\yn county, for some of the cases mentioned in this 
paper; also, to Dr. Ratchford, of Cincinnati, who kindly 
furnished me with interesting data of his experiments in 
regard to leucomain poisoning, and his conclusions 
deduced from these experiments. 



A Criticism of Modified Milk and of Modern 

Dairy Methods.* 

When we consider that the present science of lactol- 
ogy, if I may be allowed to coin a word, is really only 
about a dozen years old, the progress that it has made is 
both a matter for congratulation and a promise of much 
better things.' Ever since the prehistoric animal wet 
nursing of Romulus and Remus, the milk of animals has 
provided an ever increasing supply of human food. And 
while I hesitate to accept Prof. Rotch's^ gloomy prog- 
nostication, that the coming woman will be a poorer 
nurse than the mothers now living, it is easy to see that 
milk and its products will be more and more in demand 
for human sustenance, as time goes on. 

The great importance of every aspect of the subject is 
sufficient excuse, if excuse be needed, for bringing it 
before this learned society, among whose members there 
are doubtless many gentlemen fully able to discuss the 
points brought forward and thus add to the sum total of 
recorded knowledge of the science of lactology. 

As just said, the advance in the knowledge of this 
subject has, of late years, been remarkable, and there is 
every reason to agree with Prof. Conn^, who says, "In 
the immediate future we can see still further practical 

*Read before the Medical Society of New Jersey at its annual meeting at 
Atlantic City, June 2a, 1897. 


results, and can, in the light of our knowledge today, 
feel confident that within ten years the discoveries in 
bacteriology will produce a complete revolution in 
almost every branch of the dairy industry." 

There are many aspects of the dairy question ; too 
many, in fact, to be discussed in one short paper. I will 
therefore, with your kind permission, confine what I have 
to say to some remarks upon milk as food from the 
clinician's standpoint. 

If the systemic writers upon this subject disagree 
in certain respects, they all practically agree in one, viz.: 
That if a baby must be fed on cows* milk the composi- 
tion and character of the milk should be more or less 
modified in practically every instance. Just what these 
changes should be in a particular case, cannot be settled 
in a wholesale way ; because no two infants require 
precisely similar food, and because, also, the constituents 
of milk may vary within considerable limits and yet it 
may agree perfectly as food. Nor has it yet been 
definitely settled exactly what changes should be made 
in milk nor precisely what conditions should be observed 
in its production and care before it is offered as food to 
the average infant. 

I do not think that we can yet assert that the superi- 
ority of cows* milk as a food for human beings has been 
established over that of the mare, the ass, or the goat, I 
am aware that Prof. Rotch and other authorities are 
strongly disposed to think that with our improved dairy 
methods and milk laboratories, cows' milk can be so 
advantageously modified and preserved for food that it 
will hardly be worth while to experiment with the milk 
of other animals. While this view of the case may be 
right, still I doubt whether we have done our full duty to 
our infant patients until we have made or caused to be 

ESSAY. 167 

made an Extended series of experiments in feeding 
them with the milk of other animals than the cow. 
The milk of some of the non-ruminating animals, such as 
the ass and the mare, approaches more nearly in chemical 
and mechanical composition to human milk and has 
from time to time been used for infants* food. If there 
exist any statistics tending to show the relative food value 
of the milk of other animals as compared to that of the 
cow, I have failed to find them. 

It seems probable that the milk of asses, mares or goats 
is used less in this country for human food than formerly. 
Whether there may be truth in the assumption* that 
because the two first-named animals do not chew the cud 
their milk would agree better with children, can only be 
proved by actual experiments carried out on an extended 

It is certain that the Kurds who inhabit the steppes of 
Tartary subsist largely upon mares* milk, which is made 
into koumiss ; as some assert, to produce the exhilarating 
effect of the small proportion of alcohol which the 
fermentation generates. These mares have unusually 
large udders and are not broken to work but are kept as 
dairy animals. 

Gilman Thompson' says: ** Experiments in feeding 
children direct from asses were carried out in Paris, in 1883, 
at the Hospice des Enfans Assist^s.. One ass was suffi- 
cient to nourish three infants, beside her own foal. 
The asses were kept near the ward and the infants were 
brought to them to nurse. Syphilitic infants, belonging 
to a class of which previously all had died, were thus 
nursed and seventy per cent, of them were saved. The 
experiment does not seem to have found favor elsewhere. 
Goats were first tried, but proved of no service for direct 


The obvious objections to causing infants td suck their 
food from the teats of any animal are very great and 
perhaps, as a general thing, insurmountable. Still there 
seems to be no valid reason why asses* milk should not 
be produced and sold like other dairy milk for the use of 
delicate infants and invalids. The ass is a hardy, docile 
and long-lived creature, and is presumably far less liable 
to disease than the cow. 

Statements very similar to the foregoing are made, 
concerning the advisability of milking goats for food, by 
Schwartz.^ ^ This writer deprecates sterilized cows* milk 
as lacking in nutrition for infants, and states that goats* 
milk does not require boiling, inasmuch as the goat is 
less susceptible to tuberculosis than the cow, and more 
particular in the selection of its food. And as its milk so 
nearly approaches human milk in composition, it is 
better adapted than that of the cow for the nourishment 
of delicate children and invalids generally. 

The fact that Pasteurization of milk seems to answer 
nearly or quite as good a purpose as sterilization, 
obviates part of Schwartz's objection to cows* milk. 
Still, the milk from the best dairies, even when modified 
at the laboratories-, will not agree with every infant ; and 
it would often be of great advantage if there were regu- 
lar provision made for furnishing asses* or goats* milk for 
delicate infants. 

It is an exceedingly encouraging sign of the times 
that the more enterprising dairymen themselves have set 
to work to improve their own methods. The results have 
been most encouraging so far as the betterment of the 
dairy products goes, and it is to be hoped that the enter- 
prise and thrift of the pioneers in improved dairy 
methods have been well rewarded pecuniarily. The 
result is inevitable. In a few years as nearly perfect a 

ESSAY. 169 

system of dairy farming will have been reached in this 
country as practicable, and the poor, unwholesome and 
badly-kept dairies will be driven out of the business. 

The resulting improvement in the health of the com- 
munity can scarcely be estimated, and it shoyld be our 
duty, as physicians, as well as our pleasure, to do every 
thing in our power to further this laudable movement. 
The dairymen have already called to their aid the best 
available scientific and sanitary talent, and have shown 
commendable zeal and sagacity in carrying out the sug- 
gestions made to them, and in putting to a practical test 
the experimental knowledge from the laboratories. 

There is yet much to be done. It is partly as a protest 
against the feeling which seems to exist in certain 
quarters, that modified milk is the summum bonum of 
infant and invalid food, that this paper has been written. 

Milk is an article so complex in its composition, so 
variable in the quantity and nature of its constituents, 
and so exquisitively sensitive to a number of very slight 
variations in the conditions of its production and care, 
that it can be truly said that we have not yet grasped its 
essential nature and, perhaps, never will. There are 
properties in milk which can not, by any means at pres- 
ent at our disposal, be isolated and studied. As, for 
instance, the substance or substances which give the 
delicate odor to pure, fresh milk. No doubt, most, if 
not all, of the chemical and mechanical changes which 
occur in milk are due to the presence and activity of 
microbes and to their products. But if tyrotoxicon, for 
example, is due to the action of a microbe, the organism 
has never been isolated. Prof. Vaughan* spent two 
years in isolating the poison itself. He got a peculiarly 
virulent substance with certain ascertained properties. 
But how it was developed, or its source, he could not 


determine. It does not develop at a temperature below 
60° F., and is anaerobic. It has,' I believe, no sensible 
properties by which we can distinguish its presence. 
However, a dog, when offered cheese which contained 
the poison, and some which did not, chose the latter ; 
his much keener nose probably warning him of the pres- 
ence of an injurious substance, which was probably not 
of the nature of putrescent matter, since dogs do not 
reject carrion as food, but often bury their bones, digging 
them up and eating them after they are ripe. 

From this we might infer that tyrotoxicon is not a 
direct product of decomposition, but an accompaniment, 
or, perhaps a cause of it. At all events, its capacity for 
harm seems limitless. An epidemic of tyrotoxicon 
poisoning at Long Branch in i886,* was traced to some 
milk which had been milked at noon and immedi- 
ately turned into cans without having been cooled, 
and carted eight miles in the sun on a hot day. 
To this substance are doubtless often to be attributed 
the suddenly fatal attacks of cholera infantum which 
in hot weather. It is also fair to con- 
he convulsions, temporaiy paralyses and 
of nerve poisoning which attack artific- 
in hot weather, and arc, perhaps, errone- 
I to teething, as due to tyrotoxicon 
: an interesting fact that a temperature 
ver, is necessary for the development of 
i that a continuous temperature of 60" 
IS to be essential to the development of 
cholera infantum, a disease once sup- 
ed solely by the continuous high tempera- 
luchasit is practically a disease of artifici- 
it is probably caused by tyrotoxicon 
tunately. as said above, the researches of 

ESSAY. 171 

Vaughan and others have shown that the substance 
can not develop in a lower temperature than 60^ F., 
nor in a free current of air, so that milk properly aerated 
and cooled immediately after milking will not contain 
this substance. 

The antitoxic property of fresh milk is another inter- 
esting phase of our subject. It was first demonstrated 
by Fokker,'' that fresh milk destroys the vitality of cer- 
tain bacteria. Sternberg® says that "Ketscher, in 1892^ 
obtained evidence that the immunizing substance in 
animals, which have received protective inoculations, is 
contained in the milk of females thus treated.** Andj 
again,* **the antitoxic value of the milk of an immun- 
ized cow or goat, as compared with that of its blood, is 
estimated by Ehrlich and Wasserman, as from one 
to fifteen, to one to thirty — usually about one to twenty.'^ 
In another place^® he says "the immunizing value of 
the. milk of an inoculated goat was found to be 1,600 
units. After precipitation of the casein, the milk still 
retained its antitoxic power unimpaired.*' Hesse^* 
asserted that uncooked milk has the power of killing 
cholera germs within twelve hours, which, however^ 
Basenau denied. Schmidt and Pflantz,^* of Vienna, 
have published the results of a series of experiments 
made to ascertain whether human milk, like the blood of 
new-born infants, possesses anti-diphtheritic properties. 
For the purposes of comparison, they also examined the 
blood obtained from the placenta after severance of the 
umbilical cord. Their results are as follows : — The anti- 
toxins found in the blood of a lying-in woman are also 
found in her milk. The antitoxins of the milk pass into 
the digestive tract of the suckling child and then into its 
circulation without undergoing any change. It is gener- 
ally recognized that suckling children rarely suffer from 


Not to multiply quotations, we may fairly assume the 
antitoxic power of fresh milk which, indeed, Prof. 
Conn^* says has been abundantly verified by more 
recent work than that of Fokker, already alluded to. 
I might have observed, in passing, that we must in future 
modify the assertion, which we have all been so wont to 
make, that milk is a perfect culture-medium. It is, evi- 
dently, under certain conditions, an unfavorable medium 
for the cultivation of the cholera germ and, doubtless, 
for other bacteria as well. Prof. Conn's conjecture is 
that the growth of the cholera germ is inhibited by the 
multiplication of the lactic organisms, although Base- 
nau's experiments^' seemed to show that the comma- 
bacillus would continue to flourish even after the coagu- 
lation of the milk. 

The study of the germicidal properties of milk of all sorts 
and degrees, evidently will furnish an interesting field for 
investigation for a number of years to come. And the 
results of the study promise to be of great importance to 
the clinician and to the dairyman also. It seems to me 
perfectly fair to assume that the comparative immunity 
of sucking children to various infectious diseases may be 
partly explained by this peculiar property of fresh milk. 
And other things being equal, it is exceedingly 
desirable to retain in milk this antitoxic property until 
such time as the milk may be used as food. 

Another interesting peculiarity of milk to which I have 
alluded incidentally, is its reaction. This is said to be per- 
sistently alkaline in human milk and acid or amphoteric 
in cows' milk. It is always said that alkaline milk would 
be much more wholesome for babies than acid milk, and 
various chemicals, such as bicarbonate of soda, salicylic 
acid, borax and so on, have at times been added to milk to 
keep it from change or to render it alkaline. These 

ESSAY. 173 

substances are all said to be unwholesome and their use 
seems to have been abandoned entirely in reliable dairies. 
Prof. Rotch^' tells us that cows pastured on the blue 
grass of Kentucky, in which the proportion of nitrogen- 
ous matter to the other ingredients has been found to 
be about i to 4.5, give neutral or alkaline milk. This 
would also seem to be true of the well-known Sheffield 
Farms Company's milk, which comes from Delaware 
County, New York State, where much lime-stone is 
alleged to abound. Also the so-called Rockland milk, 
which comes from lime-stone regions, is said to possess 
the same peculiarity. There are a number of dairy 
farms on the islands of Lake Ontario where the pasturage 
grows amongst the lime-stone rocks. The milk of these 
dairies, as I am informed by a reliable observer, can be 
poured without cooling, into cans and brought ashore, in 
some cases a distance of eight miles, in a row-boat and 
thence shipped to Syracuse and other points without 
souring. Rotch says that a daily feed of ten pounds of 
sugar beets to each cow, or even to a quarter of the herd, 
will cause the milk of a dairy to be neutral or alkaline. If 
this is so, it would appear probable that the animal requires 
hydrocarbonaceous rather than nitrogenous food for the 
production of alkaline milk. This is a very important mat- 
ter as it seems to me. If ordinary milk poured without 
cooling into cans and carted away to the consumer in hot 
weather will develop tyrotoxicon, while milk originally 
alkaline can be moved long distances without cooling 
and will not sour or undergo other serious change, and 
if this quality of alkalinity can be secured by providing 
suitable diet, the commercial value of the discovery 
must be almost without limit. So far as I know, no ex- 
tended observations have been reported on the superiority 
of alkaline over acid milk as an infant food, and this phase 


of the question offers also an attractive field for research. 
Still, reasoning from analogy and from the known 
properties of milk, this comparatively stable alkalinity 
must be a very desirable thing in infant food, and that it 
may be caused by the food of the animal is not in the least 
improbable, a priori. I believe that it is undisputed that 
brewers' grains markedly increase the acidity of dairy 
milk and that all dry feed makes the milk more acid than 
fresh grass. The exquisite sensitiveness of milk to any 
change in the food or surroundings of the milch-cows, is 
too well known to require comment ; still, it may not be 
so well known that the essential properties of the milk are 
changed by what seem at first blush, very slight 
causes. As, for instance, Pearson*'' says, **that the milk 
drawn by a quick milker will contain the more butter fat, 
although the slow milker will get as much milk from the 
cow as the more rapid one." Russell has pointed out 
the interesting fact that the number and kind of bacteria 
present in milk differ according to the treatment which 
the animals have received* 8. 

It is said * • that I, coo litres of the milk of cattle pastured 
in the hill districts will yield i8 kilogrammes more 
cheese, butter and ricotto (poor cheese) than the milk of 
cattle pastured on the plains. 

The withholding of salt from milch-cows has been found 
to result in a falling off of seven per cent, in the quality 
and twenty-seven per cent, in the quantity of the milk. 
This writer*® goes on to speak of the feeding and 
care of dairy animals as follows : **A11 changes of diet 
must be made with caution. The utmost vigilance must 
be exercised in seeing that regularity of feeding and 
milking be observed, and that the latter process be 
thoroughly performed. The cows must also be guarded 
against extremes of heat and cold. Through inattention 

ESSAY, 175 

to these particulars the flow of milk may easily be 
so diminished as to render the keeping of a dairy a profit- 
less business.** 

Speaking of the effects of a change of diet upon 
human milk, Rotch** gives a case in which a wet nurse, 
who had been accustomed to a poor and meagre diet, 
and was, when she began to nurse a foster-child, put upon 
a rich and varied diet. For the first month, all went 
well with the nursling, but after that, trouble began. 
The infant became violently " colicy ** and began to 
vomit curds, which were large and firm, and resembled in 
every respect the curds vomited by a child fed on cows* 
milk which does not agree with it. It would be interest- 
ing to know whether the reaction of this human milk 
was acid. As Rotch informs us (contrary to the usually 
accepted opinion) that woman's milk may be sometimes 
neutral, rarely acid. 

We are told that alcohol taken by the nursing mother 
may reappear in the milk, to the detriment of the 
child ;^^ and if malt be taken in excess, the micro- 
organisms peculiar to malt may be found in the milk 
(Zaleski). Therefore, there may be said to be no room 
for doubt, that almost any change in the character of 
milk may be expected from a change in the diet of 
the milch-cow. 

As to the bacteriology of milk, the limits of this paper 
will prevent its consideration, even if the same would 
repay us for the time and trouble which it would take. 
Some time ago there were at least two hundred varieties 
of bacteria known in milk, of which the vast majority 
are probably harmless.** Conn says that the forms of 
fermentation are almost as varied as the number of 
bacteria themselves. And in another place** he says : "Up 
to the present time, the examination of the species of 


bacteria found in dairy products has simply resulted in 
increasing the list of forms known and described, with- 
out, as yet, coming to any conclusion as to the extent of 
the variety or the actual condition of our bacterial 
fauna. The problem is a large one and can only be set- 
tled as the result of work of many years.'* 

Many curious changes in milk have been demonstrated 
to come from peculiar bacteria, but we cannot go into 
the matter now. A sentence which I will quote from 
Dr. de Schweinitz's address, entitled, **The War with 
the Microbes," shows very graphically the many uncer- 
tainties which obscure the problems of lactic bacteri- 
ology. He says:*' "These products (of microbic action) 
are all characteristic of the individual organism. The 
conditions under which the most poisonous ones are 
formed seem to be dependent partly, we may say, upon 
the humor of the germ and also upon the food offered for 
Its use. 

There are still unsettled some very important ques- 
tions as to the conveyance of infectious diseases by the 
means of milk ; and to these questions, it is especially 
our duty to devote our attention. In a recent report on 
the ** Influence of Milk in Spreading Zymotic Disease,"**^ 
Mr. Ernest Hart, editor of the ** British Medical 
Journal,** states that he has collected evidence of ninety- 
five new epidemics caused solely by milk infection. Of 
these, forty-eight were outbreaks of typhoid fever, thirty- 
two of scarlatina, and fifteen of diphtheria and diph- 
theria-like throat affections. He says that he is confident 
that this number, large as it seems, "but touches the 
fringe of the matter.*' In nearly every case a cause was 
found upon the farms to explain the epidemic. When 
the disease was typhoid fever, some one there was suffer- 
ing from it, and the milk cans were washed with water 

ESSAY. 177 

contaminated with infected dejecta. When the epidem- 
ics were of scarlatina, members of the farmers* and 
dairymen's families were sufferers therewith, or the 
cattle themselves had a disease that bacteriologists 
declare is the same to animals as scarlet fever is to men. 
When diphtheria was conveyed, there were cases of diph- 
theria found to account for its spread. 

If, as the above quotation asserts, there is a disease of 
milch-cattle which will convev scarlet fever to human 
beings through the milk, it ought . to be thoroughly 
studied, and the profession in general ought to be 
apprised of the whole matter. I have met with the 
occasional assertion that there is a disease which affects 
the udders of milch-cows, which it was thought might 
convey scarlet fever to human beings, but nowhere have 
I ever seen the categorical statement made as above, 
that there is a disease of milch-cattle which will actually 
do this. Upon this important question we need more 

Theeditor of the** American Medico-Surgical Bulletin** 
in commenting upon Mr. Hart's report, says that our 
present methods of milk inspection are almost worthless. 
The benefit that results is not at all commensurate with 
the cost. There is little or no protection to the public 
health derived therefrom. Chemistry is of but little aid 
to hygiene in this direction. Even bacteriology is not 
capable of guarding the public properly against the 
danger that menaces us through milk. 

There is one other very important point upon which I 
would like to speak before drawing this somewhat ram- 
bling paper to a conclusion, and that is the injury which 
is done to milk by transportation, and perhap3 by some 
of the processes through which it is put in preparing it 
for market, or for invalid or infants* food. From obser- 
1 2 


vation of the digestibility of milkman's milk in cases 
where it forms the food of infants, I came to the conclu- 
sion some years ago that, first, the sooner the milk is fed 
to the infant after it is taken from the cow*s udder, the 
better ; and second, the less milk is agitated and moved 
about before the infant gets it, the better. With your 
permission, I will quote two or three cases. 

Case /.— B. N., aged nine months, third child, of 
healthy parents. Had been exposed to malaria; was 
fed upon diluted • cows* milk. Child did not prosper; 
was much afflicted with colic; vomited hard, large curds; 
also passed finely chopped curds by the bowels, which were 
very loose ; the child was weak, feverish and fretful. Various 
changes in the food were made and different patent foods, 
such as Mellin's food, Lacta Preparata, barley water, etc., 
were tried with only slight improvement. On inspecting 
the milk, which the child received, it was observed to 
contain, at times, globules of butter. This seemed to be 
due to the fact that the milk was transported for some 
distance on land and then conveyed about a mile and a 
half in a row-boat. Arrangements were made by which 
the milk was brought to the child in a fresher state, with 
very much less agitation, and gradual improvement in 
the case ensued. 

Case 2. — E. C, aged, when I first saw the case, four 
months and twenty days ; third child, of healthy parents ; 
weight at birth, 8 pounds. Was fed for the first three or 
four weeks with cows* milk and water ; also, was allowed 
to nurse the mother, who had a fever followed by pneu- 
monia. At five weeks the child was put upon modified 
milk, prepared by the Rotch- Meigs formula. The child 
did not prosper. When four months old, was put upon 
milk from the Walker-Gordon Laboratory, in New York 
city. After three weeks upon this food I first saw the 

ESSAY. 1 79 

child. It then weighed nine pounds, four ounces, 
although it was a child of large frame. The emaciation 
and general wretchedness of the little patient were 
extreme. The mother informed me that for several days 
and nights the child had done nothing but feebly toss its 
arms about and moan. The eyes were sunken in the 
head and surrounded by broad dark lines. The facies 
was pinched and anxious. The temperature was about 
I02® F. The pulse was weak and rapid, but had some 
volume. The bowels were constantly moving and pass- 
ing, in varying quantities, finely chopped hard curds, float- 
ing in greenish black water, which emitted the peculiar 
and indescribable sickening odor so characteristic of the 
stools in the chronic indigestion of infants. A careful 
review of the history and surroundings of this case, led 
to the almost inevitable conclusion that the child was 
starving to death, or being slowly poisoned, in the midst 
of plenty, with luxurious surroundings, and every care 
that affection could suggest or money could purchase, 
and fed meanwhile on the most scientific product of an 
excellent and well-conducted milk laboratory. An in- 
spection of the child's milk showed globules of butter 
floating in it ; otherwise, to smell, taste and sight, the 
milk was entirely unobjectionable. 

After a little search, a kind neighbor who owned a 
good milch-cow was found, and agreed to let the child 
have enough fresh milk for its use, morning and night. 
This milk was to be brought to the house by hand, and 
was to be agitated just as little as possible. The milk 
was to be prepared for the child by a well-known form- 
ula, first given to me by my friend, Dr. Love, for the 
preparation of gelatine, arrowroot milk. The child was 
to receive two daily inunctions of cocoanut oil, after 
having been rubbed with alcohol. She was ordered to 


be taken out in the open air as much as possible, to 
receive a little salt in her food and be given plenty of 
cold water to drink. Some pepsin and bismuth tablets 
were given for the diarrhoea, and a little brandy in the 
food until she should gain some strength. The improve- 
ment in the child's condition was as rapid as it was grati- 
fying, and a more healthy, vigorous and pretty baby of 
fifteen months, than the little girl is now, it has seldom 
been my pleasure to see. I append a short table of the 
child's weight at different dates : 

At birth, March 27, 1896, 8 lbs. 

July 10, 1896, 10 lbs., 8 oz. 

July 17, 1896, 10 lbs., 4 oz. 

July 28, began the laboratory milk. 

August 16, 1896, 9 lbs., 4 oz. 

Began the fresh milk prepared with gelatine and 

arrowroot. I 

August 23, 1896, 10 lbs., 2 oz. ^ 

August 30, 1896, 10 lbs., 4 oz. 

September 6, 1896, 11 lbs., 3 oz. I 

September 13, 1896, 11 lbs., 10 oz. 
September 20, 1896, 12 lbs., 3 oz. 
September 27, 1896, 12 lbs., 11 oz. 
October 4, 1896, 12 lbs., 11 oz. 
October 11, 1896, 13 lbs., 4 oz. 
October 19, 1896, 13 lbs., i oz. 
Had taken cold and cut two teeth. 
October 25, 1886, 13 lbs., 8 oz. 
November i, 1896, 13 lbs., 15 oz. 
November 8, 1896, 14 lbs., 4 oz. 
November 22, 1896, 15 lbs., 5 oz. 
December 7, 1896, 16 lbs., 12 oz. 
March 27, 1897 (one year old), 20 lbs. 

ESSAY. 1 8 1 

I could give several other cases in which similar results 
were obtained by similar methods in. my practice and 
that of my medical friends last summer. I would not be 
understood as having a word to say against the milk 
laboratories nor against the great improvements in modern 
dairy farming. I believe, with a recent writer from 
Chicago,*'' "that the milk laboratory has come to stay.*' 
As this gentleman puts it, **a definite prescription for 
the regulation of the necessary constituents of a liquid 
food, to be compounded, by a competent manipulator, 
aided by all the requisite paraphernalia for carrying out 
the physician's idea, is the demand of the hour^ If I 
had had any doubt of the advantages afforded to city 
infants, who can not be nursed by a woman nor get near 
enough to a cow to be fed milk only a few hours old, a 
remark of Dr. Holt's would convince me of the enormous 
possibilities of the milk laboratories for good. Dr. Holt 
said in a recent meeting,*® that he had succeeded in 
nourishing certain delicate infants on peptonized skim 
milk when the stomach had rejected everything else, thus 
indicating the wide range through which the composition 
of milk may require alteration before it can be in a fit 
<:ondition for infant food in a special case, and also shov/- 
ing the great food value, in certain cases, of skim milk, 
the sale of which, for human food, is forbidden by the 
New York State laws. 

Another great advantage of modern methods of pre- 
paring cows* milk for infants* food, is undoubtedly the 
cream separator. Although Moore** has demonstrated 
that the cream and skim milk taken out of the separator 
are not sterile, still the mechanical, as opposed to the 
gravity separation of cream, offers many advantages, one 
of the principal of which is the fact that the number of 
bacteria is much lessened in the cream and skim milk. 


most of them finding their way into the slime which the 
separator throws out of the milk. 

These investigations of Moore's were, it appears, mainly 
made with reference to the presence or absence of the 
tubercle bacilli in the milk and cream, and his conclusion 
is that all milk whatever must be sterilized or Pasteurized 
as soon as practicable after milking to render not only 
the milk and cream innocuous, but the butter and cheese 
as well. Our dairymen seem to object to the universal 
Pasteurization of their milk. Truth compels us to state, 
however, that with our present knowledge, no other abso- 
lutely safe course is open to us. 

Some most interesting points in the matter of tubercu- 
losis in cattle have recently been emphasized, to which I 
will merely allude before I close. De Schweinitz'® tells 
us that Prof. Bang, by isolating the calves of tuberculous 
cattle and feeding them on boiled milk, has succeeded in 
keeping them free from disease in a number of experi- 
» ments which he has been able to carry out on large 
estates. Prof. Bang has also pointed out the fact that 
small herds of cattle are rarely tuberculous. Dr. Theo- 
bald Smith^^ insists that cattle should be housed as little 
as possible. He says that even if the tubercle bacilli be 
scattered about outdoors, the greatly diluting effect of 
the open air reduces the danger of infection to a mini- 
mum. De Schweinitz insists, also, that all skim milk 
intended for the food of pigs and calves must be steril- 
ized to prevent the spread of tuberculosis and other 
diseases among them. There seems to be little doubt 
that cattle suffer from crowd poisoning and that tuber- 
culosis breaks out among them from too much confine- 
ment, in the same way that it does among the animals in 
a menagerie, and the danger of infection increases in 
geometrical progession with the number of cattle confined 

ESSAY. l8j 

in one place and the number of hours of confinement in 
the twenty-four. For this reason alone the solitary cow 
or the two or three cows in one stable are very much less 
liable to tuberculosis than the cattle in a herd. 

Alvord^^ makes an excellent suggestion for keeping 
the milk free from contagion, which, I am informed by a 
practical dairyman, is entirely feasible, viz., that in milk- 
ing, the cow should be led away from the stall or place 
where she usually stands — for here her companions also 
stand and set free countless microbes from their bodies, 
their exhalations and secretions — to a sheltered but 
airy spot like a large open shed or, perhaps, in summer 
time, under a canopy or netting. It would seem that 
this could easily be managed — to lead the cow (she 
should never be driven if it can be avoided) into a cool 
and well- ventilated place from which flies and other 
insects could be excluded by netting for, at least, the 
time necessary to milk her. This place might have a 
cement or tiled floor, which could be kept completely dis- 
infected, and in this way one principal cause of the 
infection of milk could be avoided, to wit : the contamin- 
ated dust of the cow stable itself. And if the flies and 
other insects could be kept off the cow and the milker 
during the important process of milking, the milk itself 
would probably be much better. 

Alvord points out, in the same publication, a fact which 
probably every practical dairyman knows, but which, I 
dare say, is not generally known to others, viz., that the 
milk of good cows often is too rich for their calves, and 
the latter are apt to take too much if left to themselves. 
Therefore, the calves should be taken away from their 
mothers and should be fed modified milk. This is only 
what we should expect when we reflect that the modern 
high grade cow is a highly-developed milk machine and 


that her calf is not brought up under strictly natural condi- 
tions, any more than the young of the human species 
grows up as nature intended him to. Fortunately, the 
day of rationalism in medicine has begun to dawn and 
the clouds of superstition and ignorance are fleeing away. 
Whatever evils can be prevented by scientific foresight 
and hygiene we are, today, struggling to get rid of. We 
rely less upon drugs than our ancestors did, but more 
upon common sense and scientific knowledge. In the 
words of the honored Secretary of this Society,** ** It is 
only by removing or obviating the causes of disease in 
general that medicine will make any real advance." 

In conclusion, I would sum up my observations as 
follows : 

1st. Some occult but irreparable injury occurs to milk 
commensurate with the lapse of time since the milking 
and the amount of agitation to wfiich it is subjected. 

2d. While this change is delayed and modified by 
cleanliness and modern dairy methods, especially by a 
continuous low temperature, it can not be prevented. 

3d. Therefore, milk should be fed to infants as soon 
after the milking as possible and should receive the mini- 
mum of agitation or movement. 

4th. The modern high grade cow is a specially devel- 
oped milk machine and is consequently very liable to 
disease, and is remarkably sensitive to changes of diet, 
water, shelter and treatment. 

5th. It is by no means settled that for the production 
of infants' food, the ass or the mare, or even the goat, 
might not be superior to the cow. 

6th. The modern cow is especially liable to tubercu- 
losis, and this liability increases in geometrical progression 
with the number of cows kept in one stable and the 
number of hours in the twenty-four during which they 
are housed. 

ESSAY. 185 

7th. With our present knowledge the, conclusion is 
inevitable that all cows* milk intended for any form of 
human food should be Pasteurized and aerated immedi- 
ately after milking, and then kept at a uniform tempera- 
ture of about 40^F. 

8th. The spread of tuberculosis amongst cattle can 
be greatly modified, if not prevented, by, first, separating 
them into very small herds — say, for instance, into 
squads of six — which can be fed, milked and cared 
for by one man ; and second, by keeping the cattle out of 
doors just as many hours as possible during the twenty- 
four ; and third, by sterilizing all the milk which is fed 
to the calves ; and fourth, by keeping the latter away 
from other cattle and from all sources of infection. 

9th. To ensure healthy cattle, they should be housed 
during the winter in high, dry stables into which the 
sun*s rays shall penetrate all day long. 


1. Rotch*s Pediatrics, p. 214. 

2. Bulletin No. 25, U. S. Dept. Agriculture, 1895. 

3. Practical Dietetics, p. 49, 

4. Popular Science Monthly, Vol. 35, p. 214. 

5. Op. Cit., p. 215. 

6. Encyclopaedia Briltanica — Article on Milk, by James Paton. 

7. Immunity and Serum Therapy, p. 33. (Sternberg.) 

8. Op. Cit., p. 116. 

9. Op. Cit., p. 1 59. 

10. Op. Cit., p. 261. 

11. Deutsch Med. Wochenschrift, No. 40, 1896. 

12. American Journal of the Medical Sciences, Vol. CXI., p. 122. 

13. North American Practitioner, Dec, '96, p. 544. 

14. Dairy Bacteriology, Bulletin No. 26, U. S. Dept. Agriculturr, 

1895, p. 9. 

15. Archiv. der Hygiene, XXIII., p. 170. 

16. Pediatrics, Op. Cit. 


17. Pearson — " Facts About Milk," Farmers* Bulletin, No. 42, U. S, 

Dept. Agriculture. 

18. Twelfth and Thirteenth Annual Reports Bureau Animal 

Industry, 1897, p. 263. . 

19. Encyclopaedia Brittanica — Article, Dairy. 

20. Op. Git. 

21. Pediatrics, p. 212. 

22. American Text Book of Obstetrics, p. 769. 

23. Souring of Milk, Farmers' Bulletin, No. 29, 1895, U. S. Dept. 

of Agriculture. 

24. Dairy Bacteriology, Bulletin No. 25, etc., p. 16. 

25. American Medico-Surgical Bulletin, June 10, '97, p. 497. 

26. Science N. S., Vol. V., No. 119, p. 561, ei seq, 

27. Dr. A. C. Colton — Journal American Medical Association^ 

June 5, '97, p. 1065, et seq, 

28. The May i8th, '97, meeting of the Section on General. Medicine^ 

N. Y. Academy of Medicine. 

29. Year Book, U. S. Dept. Agriculture, 1895, p. 431, et seq, 

30. Year Book, U. S. Dept. Agriculture, 1894, p. 343, et seq, 

31. Year Book, U. S. Dept. Agriculture, 1894, p. 327, et seq. 

32. Farmers' Bulletin, No. 55, 1897, Dept. Agriculture, p. 18. 

33. Dr. Wm. Pierson, of Orange, N. J., at the May, '97, meeting of the 

Orange Mountain Medical Society. 



Some Impoutant Points for Consideration in the 
Treatment of Acute Lobar Pneumonia. 

The proceedings of our medical societies are sometimes 
criticised by superficial observers and by those who do 
not take an earnest part in the work, for the frequent 
recurrence of old topics and the absence of novelty and 
originality. Such persons mistake the office of the scien- 
tific medical society and the motives of those workers 
who can always be counted upon to express freely, 
honestly and with humility what they know, or to acknow- 
ledge their ignorance of any subject that may be brought 
forward. . The object of the work is more to crystallize 
truth than to disseminate what is new. Such novel 
information has a spreading power in itself that easily 
carries it to the whole profession. In the medical society 
men gather to compare, correct and fill out their experi- 
ence. Here the immature views of young men germinate 
and develop, while even the oldest has his established 
beliefs pruned into better form by free discussion. 

The introduction of the subject of pneumonia without 
the excuse of any original observations, without any new 
statistics or any favorite plan of treatment, requires only 
the excuse that we are still seeking the best plan of 
management. Every physician has some mode of pro- 
cedure that he has acquired from his preceptor or has 


carried from his hospital. That any one shall approach 
the treatment of a case of acute lobar pneumonia with 
confidence of a successful outcome, is impossible so long 
as the present death-rate remains. A mortality approach- 
ing 25^, which has not been materially diminished in 
modern times, is certainly sufficient excuse for free and 
frequent discussion. 

There are two ways in which the treatment of disease 
may be advanced. By a gradual improvement in the 
details of treatment, with a better appreciation of the 
disease and an improved technique ; or some specific 
treatment may be discovered to suddenly supplant all 
previous plans and immediately reduce mortality. The 
improvement in the treatment of typhoid fever is an 
illustration of the first ; diphtheria is an instance of the 
second. A number of specific treatments of pneumonia 
are claimed each year, but improvement is still confined 
to the elaboration of a better technique. 

I will touch upon four points — feeding, the prevention 
of delirium, hydrotherapy and stimulation. 

As to diet. In acute lobar pneumonia, it has always 
seemed to me that the tendency was rather to overfeed. 
It is questionable, in the acute stages of the disease with 
the undoubted accompanying congestion of the abdom- 
inal organs, whether harm is not often done by stuffing 
the stomach with milk to the production of large quan- 
tities of gas and upward pressure on the diaphragm. 
Now and again a feeble voice is raised against over-feed- 
ing in pneumonia. The lesson of feeding in other febrile 
disease has been so well learned that the shortness of the 
course of pneumonia is not enough considered. There 
are undoubted benefits in restricted diet in a disease so 
acute. Over-feeding means a consumption of physio- 
logical force in the digestion and assimilation of food. 

ESSAY. 189 

It means the diversion of so much energy from the repar- 
atory forces of the body to the. digestive forces. It 
means the throwing into the circulation a quantity of 
crude food products that must be taken care of. It 
means the presence in the intestinal canal of the waste 
matter of the food that must be gotten rid of. The 
patient dying in acute pneumonia does not die from a 
lack of more remote reserve force such as might be pro- 
duced by a system of stuffed feeding, but rather from the 
failure of the development, when needed, of the latent 
force already existing. If, by a system of over-feeding 
such as would produce this more remote force, part of 
our stock of immediately available energy is used up, 
more injury than good is done. It is just as if the 
captain of a ship with an important and pressing com- 
mission should stop to replenish the coal supply on the 
wharf when he should be on his journey, burning the 
supply in his well-filled bunkers. Diet should be bland 
and moderate in quantity. It would seem that only a 
misconception of the conditions of pneumonia leads to 

There is no diesase in which it is more important to 
discount future events. An acute delirium in an alco- 
holic patient, when fully developed, frequently means a 
fatal termination. The feeble power of drugs to control 
this delirium, short '6f paralyzing the patient with dan- 
gerous doses, is only too well known. If at the outset 
of pneumonia in an alcoholic case we foresee that the 
day of delirium is bound to come, we can, by the free 
use of sedatives, avoid, or at least limit the delirium of 
the later days. 

The bromides are not sufficiently appreciated for their 
good qualities in acute disease. Their harmkssness has 
been so impressed by the experience of treating a latge 


number of epileptics, who took continually enormous 
quantities, that it has seemed desirable to consider their 
usefulness in other conditions. The reason that the bro- 
mides have so little reputation in emergencies, compared 
with morphine, chloral, hyoscine and the hypnotics, is 
that they have been given in too small amounts. Other 
drugs get more fair treatment. We push them until we 
accomplish the result aimed, or until the appearance of 
some danger symptom. With bromide, single doses of 
from five to thirty grains are too often given, and then 
resort is had to some other expedient. A solution of 
bromide well diluted is not irritating to the stomach. It 
resembles very closely in its chemical and physical prop- 
erties the saline salt solutions that we -do not hesitate to 
put directly into the veins. It has no toxicology in 
any dosage that any one would possibly apply. Its 
most glaring defects are the largeness of the dose and 
the slowness of the results. The fear of bromism that is 
constantly before some minds rests upon a foundation 
chiefly of tradition. It occurs in cases that have been 
taking large quantities for a long time, and is the result, 
not simply of the drug itself, but of mixed causes, such 
as gastric irritation and deficient elimination. 

If the alcoholic pneumonia patient is brought from the 
beginning of the disease under the influence of bromide 
in efficient quantities, the use of the more powerful and 
dangerous sedatives at a later period may be avoided. 
After delirium is once thoroughly established in pneu- 
monia, bromide is a drug toQ mild to be efficacious. It 
should be begun in the very beginning. of the disease in 
alcoholics and given freely, so that the patient shall get 
from one-half ounce to one ounce in twenty-four hours. 
Lives seem to have been saved in alcoholic cases by the 
free use of bromides from the beginning. , 

ESSAY. 191 

The third point in the treatment of pneumonia th^t 
can well be discussed is the value of hydrotherapeutics. 
In going over the recent literature of pneumonia, as 
found in the later text-books and systems of medicine, 
a restlessness and reaching out for new methods is per- 
ceived that is not found in the older ones. While we 
do not find among the conservative men who are usually 
selected as the authors of these books, one who defi- 
nitely recommends the exclusive use of hydrotherapy, 
still nearly all point to it as a possible or even probable 
improvement, and quote some other man in support. 

The great problem that confronts us in this disease is 
the maintenance of the circulation in spite of the ob- 
struction of the consolidated lung. To get the best 
results of management we must regard the circulation as 
a whole, not concentrating our attention entirely upon 
the heart or the pulmonary circulation, or the system- 
atic circulation, but always remembering that what 
benefits one part of the circuit, cannot but affect favor- 
ably the other. The stimulation of the heart and the 
use of vaso-dilators to relieve its burden, are important, 
but hydrotherapy is not frequently enough employed in, 
combatting the symptoms, prostration and blood stasis. 
The difficulties and prejudices to be overcome before it 
can be generally adopted in pneumonia are so great that 
it is with some diffidence that one undertakes to break 
ground. Hydrotherapy has been so much the property 
of men who have prostituted medical science to the ends 
of mere personal profit, that much of value has been 
lost to more conservative practitioners. No one who 
has once witnessed the splendid results of systematic 
cold bathing in typhoid fever would again be willing to 
cut off from this resource in a severe case. In the same 
way in pneumonia the effect of hydrotherapy properly 


adapted to the condition of the patient would reduce 
mortality as much as in the case of typhoid fever. It 
can never be emphasized enough that the value of 
hydrotherapy extends far beyond the liniits of the 
mere reduction of temperature. The effect is a general 
tonic to the nervous system, rehabilitating the heat- 
controlling forces of the body and restoring the tone of 
the circulation. To accomplish these results, the tem- 
perature and duration of the bath must be properly 
adapted to the case and the conditions present, but there 
is one element in the application of bathing that is of so 
much importance that we are almost tempted to alter 
our terms and speak of the treatment as tub-rubbing, 
instead of tub-bathing. While in the bath the patient 
must be properly rubbed in every part of his body by a 
sufficient number of trained attendants. Without the 
rubbing well carried out, the tub-bathing in an acute 
disease is indeed the fearfully dangerous procedure that 
it is often supposed to be by those who have not given 
the subject mature consideration. 

The Brandt method of treating typhoid fever gives a 
standard — the bath of 65 degrees, the rubbing by strong 
attendants during the whole time of immersion, the 
removal to a dry bed, the precautions that a patient 
should never be bathed when the feet arfe cold, and that 
cold feet, after a bath, should be treated by application 
of warnvth. 

Every man before undertaking the treatment of dis- 
ease by the application of cold water, would do well to 
follow a few cases of typhoid treated by this method. 
Then he would be in a position to intelligently depart 
from the set system according to the demand of each 
case. Thus, the bath may be advantageously modified 
by only filling the tub so as to half cover the patient. 

ESSAY. 193 

and trusting to the attendants to apply water to the part 
of the body not covered. A very suggestive paper by 
Dr. F. Gundrum, of California, in the Therapeutic Gazette 
of last year, emphasizes the importance of hydrotherapy 
in pneumonia. He found that by placing a blanket in 
the bath under the patient the treatment was rendered less 
objectionable. He states that in his experience packs 
were found a useful adjunct, when, for any reason, 
frequent baths were difficult to give, but whenever the 
temperature went above 103 he resorted to the baths. With 
all other writers, he emphasizes the fact that, equal in 
value with the reduction of temperature, is the general 
nervous stimulus of the cold water and the rubbing. 
The effect of cold water in health, as a refreshing and 
stimulating agent, needs to be remembered. 

Without detriment to the treatment, the baths may be 
commenced at a temperature of 80 or 90 degrees, and 
then while the patient is being thoroughly rubbed the 
temperature may be reduced by the addition of cold 
water. This lessens the shock somewhat with sensitive 

In the discussion of the hydrotherapy of pneumonia, 
curiously enough we come once more upon the old 
question of heat or cold in the treatment of disease, 
emphasizing once again the only possible answer to this 
dispute of 2,000 years* standing, that there is good in both. 
The ground for belief is strong in the experience of every 
one of you, that heat applied to the chest in pneumonia 
by poultices, hot water coils or other means, has a 
beneficial effect upon the morbid processes within the 
chest. It certainly benefits commencing edema from 
whatever cause and is said to hasten the cycle of the 
pneumonic processes. That heat is good we firmly 
believe. On the other hand, there is good authority 



from some of the best observers in the world, that' toVd 
Applied to the chest in pneumonia has also the power of 
influencing for good the cause of the' disease, cutting 
short the processes and hastening recovery. Thus, 
between heat and cold we cannot decide absolutely, say- 
ing one is good and the other bad. It is even possible 
that there are times when the very hot bath might 
benefit a desperate case. 

In the Maternity Hospital we have frequently studied 
the effect of such immersion in new-born children, in 
whom vitality was at a dangerously low ebb. The effect 
of a properly adapted bath was beautifully shown In tli'e 
case of a child of seven. The child hadpneumonia with 
a very high temperature, and rapid pulse. There wais 
much venous stasis and everything seemed to be going 
wrong. This child was put into a bath at a temperature 
of 90 degrees and thoroughly rubbed for a period of 
about fifteen minutes. When taken out of the tub and 
put back to bed its temperature had fallen, the breathing 
was quiet, the pulse improved and the whole picture had 
changed. The bathing without the rubbing w6uld not 
have accomplished any such result. 

In a discussion on the treatment of typhoid fever by 
cold bathing, in the section on Generar Medicinie, in the 
New York Academy, the influence of the baths as a 
respiratory stimulant was dwelt upon by Dr. A. Bl Ball. 
It would seem that in pneumonia this action would be 
advantageous. Its wonderful tonic effect' upon the 
nervous system, equalizing the circulation; and bringing 
about physical rest, has astonished every one who has had 
the. opporturtity of studying fever cases so treated, 
thcrpase in .the secretion of urine, sujch as is a constant 
otservaiion* in ^ever patients* who are taking l)a^iis, 
would suggest improved elimination of toxines. 

ESSAY. 195 

The reports of the treattnent of pneumonia in which 
bathing was used as a tonic and supportive measure, as 
opposed to merely anti-pyretic baths, are very meagre. 
Prof. Bozzolo says : " After a considerable number of 
observations, (i) such baths are well borne in severe cases, 
they never produce collapse ; (2) they lower temperature 
rapidly and notably, and keep it down, for a considerable 
length of time ; they may be repeated every three hours; 
(3) the mortality per cent, among patients treated thus 
with cold bath is among the lowest recorded under any 
form of treatment." — Gazetta Medica Italiana, July 2, 

The fourth and last point is the circulation in pneu- 
monia. Every thoughtful physician has a philosophy of 
his own that guides him in the choice of means of stimu- 
lation. The direct care of the heart is equal in import- 
ance to the attention to delirium and to the destructive 
forces of high temperature. Every one who has watched 
a patient with pneumonia from the onset of the disease 
to a termination, has felt that the heart was the organ 
upon which the brunt of the battle had fallen. There is 
no question of equal general importance or greater diffi- 
culty than that of heart stimulation. It is a problem to 
be approached with the utmost humility, because there 
are many points upon which it must honestly be con- 
fessed that definite facts are not known. The mechanism 
of the heart and circulation are admirably adapted to 
fulfil their functions. The heart has its wonderful nerve 
supply, both from the central nervous system and from 
the ganglia within itself. The blood vessels are governed 
by the marvellous yaso-moto system, with its millions of 
constrictors acting as regulators, whose perfection sur- 
passes the comprehension of man. The automatic action, 
of the respiratory and cardiac nervous - centres also elude 


our complete understanding. In health, the slightest 
mental or physical exertion is followed by an increased 
effort on the part of the heart and a corresponding deep- 
ening of respiration. When anything happens to cause 
obstruction to the breathing or circulation, the heart 
immediately responds with a large increase of labor to 
overcome the obstruction, and the lungs increase their 
activity to an even greater degree. 

Now, nature having provided this wonderful plan of 
increased activity to meet emergencies, the question of 
stimulation resolves into an inquiry as to whether we can, 
by artificial stimulants, supplement with advantage the 
natural stimulus that comes from the nervous system. 
We come face to face with the possibility of injudicious 
stimulation, or stimulation at the wrong time, which may 
exhaust the natural resources so that they will not re- 
spond at a more critical period. On the other hand, 
leaving stimulation, pure and simple, out of the question, 
can we not control the action of the heart to conserve its 
forces to calm the excessive stimulation of an excited 
nervous system, and in this way reserve the force required 
to tide over a critical period ? In addition to stimulation 
and control, it would seem that nutrition of the heart 
was of great importance. Particular drugs cannot be 
discussed at much length. The best general plan of 
management of the heart in pneumonia, is to conserve 
its forces early in the disease by the control of delirium 
by the use of a proper anti-pyretic, but at the same time, 
tonic system of bathing, and by the use of such drugs as 
will relax the general circulation and diminish the hyper- 
activity of the heart. Undoubtedly, with all its dis- 
advantages, the aconite group of drugs affords very 
valuable properties. 

The importance of the philosophical consideratfon 

ESSAY. 197 

that it is the right side of the heart, instead of the left, 
which is chiefly in danger of exhaustion, seems to 
impress itself with difficulty upon the profession. Dr. 
Andrew H. Smith has for a long time advocated the 
study of the pulmonic second sound as a guide to prog- 
nosis. Still it is not perfectly clear that we have any 
Qieans at hand by which we can stimulate one part 
father than another, nor indeed, with all that has been 
studied and written, is the mechanism of the circulation 
so well understood that we can proceed to a very great 
degree in the treatment of particular parts of it with 
confidence. After all is said, when we recall to mind the 
impression made upon us by a critical case of pneumonia 
at the critical period, it is of an effort to apply cardiac 
and pulmonary stimulants with the object of tiding our 
patient over. 

Before my mind is a patient surrounded by the para- 
phernalia of the sick room and the anxious attendants, 
but more distinctly there stands, out in my imagination 
a picture of a struggling heart and certain alkaloids, 
notably strychnine, atrophine, digit aline and cocaine, 
that must be applied hour by hour to keep this heart 
from failing of its task. After one has cared for a case 
like this, it is often difficult afterwards to describe just 
what doses were given, as each was administered accord- 
ing to immediate indications. In Wood & Fitz's new 
text-book on ** Practice,'* we find the following recom- 
mendation that appeals to our judgment of stimulation 
in a severe case, the drug to be given hypodermically, if 
not well borne in the mouth: Strychnine gr. 5^ every 
four hours, and cocaine gr. | every four hours, alternat- 
ing so that one or the other is given every two hours. 
The strychnine may be slowly increased to gr. j^ and 
the cocaine to gr. J. Dr. Wood thinks he has seen life 


saved by even larger doses. Certainly, a well thought- 
out and courageously applied plan of stimulation offers 
the only hope for critical cases. 

Time compels the omission of the discussion of the 
place of calomel, alcohol, belladonna, nitro-glycerine and 
digitalis in pneumonia. Nor can the place of bleeding be 
touched upon, but these will doubtless be taken up ip 
the discussion. 

Faith in the value of hydrotherapy in pneumonia is 
more the gradual growth of time and thought than a 
belief founded upon any special line of experiment, or 
the teaching of any single person. The literature, con- 
sidering its importance, though curiously meagre, is 
entirely favorable to the views expressed above. Many 
occasions arise in the course of pneumonia when a tub- 
bath of moderate temperature, carried out. with skillful 
rubbing, would benefit the patient more than a great 
deal of drug stimulation. To execute such a method 
requires courage, apparatus and skill. In advocating it 
at this time we can only hope to stimulate thought with 
the desire that means may be found to adopt this 
important measure in practical medicine. Where reason 
is convinced, no valuable addition to therapeutics must 
be discarded on account of apparent difficulty or 
preexisting prejudice. It was our privilege to witness * 
the introduction of the cold bath treatment of typhoid 
fever into a large hospital, to listen to all the same 
objections that will be raised again in the application 
of hydrotherapeutics to pneumonia, and yet we have all 
seen this method accepted by every one who has had 
the opportunity of observing cases under treatment. 

Until an antitoxin is discovered, the treatment of 
pneumonia must be in its final analysis expectant, and 
valuable though it may have been to review the various 

ESSAY. 199 

means by which the patient is protected from mortal 
injury by the disease and supported to resist it, still, in 
the application of each and every one of these measures, 
the judgment of the individual physician at the particu- 
lar time must have influence greater than the voice of 
any authority. It is this quality of judgment that is 
found in its most excellent development in the general 
practitioner occupying the field a little removed from the 
atmosphere of theoretical teaching and extreme special- 
ism. To such men it is a privilege and an advantage to 
bring the resuks of thought, study and research, and 
from them I trust my conclusions may be reflected back 
with the additional light of well-digested experience. 



Scarlet Fever Reproduced by Inoculation; Some 
Important Points Deducted Therefrom. 

The inoculations were made with a hypodermic syringe^ 
The point of the needle was introduced into the skin, 
never through it, into the subcutaneous connective tissue* 
Mucus, obtained from the throat and buccal cavity — soon 
after the characteristic eruption appeared — of a patient 
who had a mild attack of scarlet fever, was the material 
used for the inoculations. Prior to use, it was treated 
with carbolic acid, according to the suggestions of Cham- 
berland and Roux, the addition of about one six-hund- 
redth part of the acid being made. 

These inoculations were made to prove that a protect- 
ive virus had been discovered, but when I found that in 
each instance genuine scarlet fever was developed, with 
its possible complications, I desisted and turned my 
attention to another method of protecting the human 
system against the contagion of this much dreaded 
disease. However, the manifest importance of some 
facts developed by these investigations, leads me to give 
them to my professional brethren, believing they will be 
of the greatest possible practical value in the manage- 
ment of all scarlatinal patients. I should also say that 
the virus with which I inoculated the children, had no 
other than a slight local effect on white rabtits and 


Case I. — Louise R., aged 13 years. Physical condition 
perfect before inoculation; inoculation in arm, Dec. 13, 
1889, 3 p. m. , 

Dec. 14, 9 a. m. Pain in bowels and diarrhoea; both 
ceased in the afternoon, but vomited once ; during the 
evening tlfe chfirs^cteristic ^ijuptipn^jpade. its .appearance 
on the surface of the body ; skin at point of puncture, 
red ; skin, hot and dry. 

' t)ec. 15.' ' Headache; * throat sbrei'ton^u^-prfese^t^tl 
characteristic strawberry appearance r g^neraLP Whiption 

WQll'marked.'' ' '. ' • '''•■ ' • -:: •■' "\ .■. : .-i? -v,i r 

. Dec. 16. • Thiroat red, but .not sore : slept wdl; during 
the night knd feels welt; appetite good ; rash faint ;<tem^ 
perature 98.F. I i 

' Deci 17. Says she feels perfectly well ; rash very faint 
oh body, but pronounced at poiht of inoculation. . 

Dec* 18. • General condition, good; general eruption 
gone ; local eruption still manifest ; temp. gSJiFJ 

Deic. 20. Well; temp. 98J F.; desquamation^}. about 
puncture. : *  : 

Dec. 33: Throat somewhat sore again, and temp. 
162^ F.; general desquamation : case made rapid and 
complete recovery. 

' • » • * 

' Case 2, — John B., aged 11 yeai:3i Did not f^el ast well 
as usual the day before the inoculation, but did not 
specify any particular trouble ? temp^ before inoculation^ 
\oi\ F., 3 p. m. 

Dec. 13. Injected the prepared mucus into the skin 
of the arm; at midnight patient vomited and had diarr 
rhoea, also sore throat. and he&dache. 
- Dec. 14. Sick all day;, arm red, but no general: erup- 
tion. : I ' , . ) , ^- ■!..,'> . . . / , .■. ,.■:>. 

Dec. 15. Temp. loi^ F.; general eruption, but does 

.':;-:■!':: ■■- essay.:  ^ -••>■•[ ?v gos 

jftot complain of sore throat ; strawberry tongue, and 

Visible portion of throat redder than normal/ ' ti = 

Dec. i6. Rash still visible; temp. 99J F.; sayshe fefels 

well.' > ;.-; •  • '  ^ -. • : '•;.,: •'• 1 

Dec. 17.; ;i General eruption faint ; eruption about punc- 
ture most marjced ; temp. 9&f F.;" patient feels well. 

Dec. 1 8. Patient feels perfectly well ;. temp. 99 F. - 

Dec. 20. Temp. 98J F.; well ; desquamation about 

Dec/ 23. Slight general, desquamation; feels welL 
This patient made a rapid and complete recovery. 

Case J, — Andrew B., aged 6 years. Inoculated, 3 p. in., 
Dec. 13. : . . ' 

Dec. 14. Pain in stomach early in the morning ; .vomi- 
ted in the afternoon; slight diarrhoea; arm red around 
the point of injection.. 

Dec. 15. General. eruption well marked; throat sore 
and strawberry tongue ; lymphatics enlarged. 

DeCi 16. No sore throat; feels quite well ;. general 
eruption visible, but faint ; local eruption — eruption about 
puncture — ^^intense ; temp. 99^^ F. 

Dec. 17, Temp. 98^ F.; patient feels perfectly well. 

Dec. 18. Eruption about point of inoculation, but 
general eruption gone ; temp. 98^ F. 

Dec. 23. General slight desquamation ; patient feels 
quite well. 

Case ^. — Edward B., aged 8 years. Inoculated, 3 p. m., 
Dec. 13, 1889; condition normal at time of inoculation; 
vomited during the evening. 

.. Dec. 14, 7 a. m. Diarrhoea; during the afternoon, red- 
aiess about the point of inoculation ; no sore throat. 

Dec. 15. When seen, early in the morning, discovered 
general typical eruption;, throat and tongue character- 
istic in appearance. 


Dec. i6. Eruption about inoculation intense; general 
eruption well marked ; says throat is not sore ; no head* 
ache ; temp, loi F. 

Dec. 17. Temp. 98^ F.; feels well in every respect. 

Dec. 18. Feels perfectly well ; temp. 98 J F. 

Dec. 23. Still very slight desquamation. 

Case s* — Peter B.. aged 4 years. Inoculated, 3 p. m.^ 
Dec. 13, 1889; well at time of inoculation. 

Dec. 14. When he rose from bed, about 6 a. m., he 
had slight diarrhoea, vomiting and sore throat; late in 
the day, had characteristic eruption on his chest. 

Dec. 15. General eruption well marked; tongue and 
throat characteristic ; no headache. 

Dec. 16. Does not complain of sore throat; eruption 
well marked all over body ; rash about point of inocula- 
tion very intense ; feels quite well. 

Dec. 17. Patient feels quite well. 

Dec. 18. No change. 

Dec. 23. General desquamation ; urine contained small 
quantity of albumen ; had pain in left ear. 

Dec. 24, Albuminuria more pronounced. This patient 
had a sharp attack of scarlatinal nephritis, from which he 
ultimately entirely recovered. 

Case 6. — Conrad K., aged 4 years. Perfectly well; 
inoculated Dec. 19, 11.50 a. m., in left forearm; at mid- 
night of same day had fever — mother's statement — head- 
ache and nausea. 

Dec. 20. Early in the morning, found general erup- 
tion, strawberry tongue and temperature ioi|^ F. 

Dec. 21. Temp. loof F.; does not complain of sore 
throat ; general eruption well out ; appetite fair and feels 

Dec. 25. Temp, normal, and has experienced no un- 

ESSAY. 205 

toward symptoms since Dec. 21. General desquamation 
ifollowed, and the patient made a good recovery without 

Case 7. — John O'Brien, aged 2 years and I month. 
Normal in all respects except where otherwise stated. 

Dec. 21, 1.30 p.m., inoculation; 2.45 p.m., temp. 100.8 F., 
pulse 144, and p. m., 148 ; restless through the night. 

Dec. 22. Unable generally to get pulse on account of 
child's struggles ; 9 a. m., temp. lOi F., pulse 140; 7 p. m., 
temp. 101.8 F.; rash faint over sternat region; lively; 
appetite good ; swelling and redness around point of 
inoculation ; throat, tonsils and uvula a little swollen and 
.decidedly red^ tongue uniformly coated and light gray 
in color. 

Dec. 23, 9.30 a. m. Temp. 99.8 F.; throat normal ; faint 
rash on chest, abdomen and thigh ; 6 p. m., temp. 10 1.8 F. 

Dec. 24, a. m. Temp. 99.8 F.; rash and throat un- 
changed ; point of inoculation small and somewhat red ; 
p. m., temp. 100.2 F. 

Dec. 25, a. m. Temp. 98.8 F.; inoculation point begin- 
ning to enlarge; p. m., temp. 97.4 F. 

Dec. 26, a. m. Temp. 99.6 F.; inoculation point much 
enlarged ; rash more brilliant than before ; p. m., temp. 
100 F. 

Dec. 27, a. m. Temp. 99.6 F.; abscess at point of 
inoculation broke ; p. m., temp. 99.4 F. 

Dec. 28, a. m. Temp. 99.6 F.; abscess at point of 
inoculation still discharging; rash faintly visible; p.m., 
temp. 99.8 F. 

Dec. 29, a. m. Temp. 97.4 F.; abscess discharging; 
desquamation around inoculation. 

Dec. 30, a. m. Temp. 98.2 F.; desquamation on lower 
part of trunk in fine scales ; rash faded ; p. m., temp. 99 F. 


Dec. 31, a. m. Temp. 99 F.; restless during night and 
thirsty; abscess continued to discharge slightly till Jan. 13-. 

Case S, — Fritz Valentine, aged 8^ months. Normal at 
time of inoculation. 

Dec. 21, 1888. 1.30, p. m., inoculation; 2.45 p. m.,. 
temp. 99.8 F., pulse 144; and p. m., temp. 102 F.> pulse 

Dec. 22, 9 a. m. Temp. 102 F., pulse 144; restless 
through the night ; snuffles; eyes heavy; purplish rings 
beneath ; no rash or sore throat ; camphor and hot water 
brought out ho rash; 7 p. m., temp. 103 F., pulse 136; 
aconite through night. 

Dec. 23, 9.30 a. m. Temp. 101*4 F., pulse 146; no 
rash; point of inoculation purplish; not very painful; 
three yellow stools during night ; 6.30 p. m., temp. 103 F., 
pulse 136; no rash ; throat normal ; point purplish. 

Dec. 24, a. m. Temp. 101.4 F.; skin and throat nor- 
mal; four stools during night; p. m., temp. 101.6 F., 
pulse 152; faint suspicion of rash On inside of thighs 
and chest; abscess at point of inoculation opened early 
in the afternoon ; five watery stools. 

Dec. 25, a. m. Ti^mp. 100 F., pulse 136; rash faint 
but characferistic ; fhroat slightly red ; p.m., temp. 100:2 F., 
pulse 142 ; slight desquamation around point of indciila- 
tion ; six watery stools during night. - 

Dec. 26, a. m. -Temp. 100 F., pulse 166 j p. m., tiem^. 
1 01. 4 F., ptilse 120; throat normal; rash' still visible; six 
stools through night. 

Dec. 27, a. m. Temp. 100.6 F.; p. m., tfenip. 102 F.J 
riash fadedi ' ' • . . , . 

Dec. 28, a. m. Temp* lOia F.; p. m-, temip. 102 2 Fl^ 
throat and skili normal; urJnfe lessened irf quantity ; five 

ESSAY; 207 

Dec. 2I9; a. m;' Temp. 10 1.2 F.; p. m., temp, 100.4 F-l 
child WKite; doughy looking'; dark lilies under eyes ; 
passed urine three times, lessened in quantity ; acid; no 
albumen; pulse tension increased; second sound of heart 
soriiewhat exaggerated, 

Dec. 30, a. m. Tenrip. 98.4 F.; p. m., temp. 98.6 F.; 
general appearance better ; passed urine twice; acid; no 
albumen ; stools watery ; heart and pulse normal. 

Dec. 31,' a. m. Temp. 98.6 F.; p. m.,- temp. 98.6 F.; 
general appearance fairly good ; urine passed once during 
night; three watery stools ; pulse higher tension. 

Jan. I, a. m. Temp. 98.4 F.; p. m., temp. 98.4 F.; 
tirint 'pissed* oncie during night; desquamation in fine 
'scales on thighs and chest. 

Jiah^2, a. m; Temp. 98.2 F.; p. m., temp. 97.4 F.; urin€ 
abotit' normal in quantity. 

Jan. 3, k. hi. Temp. 97 F.; p. m., temp. 101.8 F.; two 
stools; urine normal. After Jan. 4 nothing occurred 
worthy of note. Desquamation was- slight and cleared 
about Jan. 10. - 

Case, 0i— yL3iTt\ijs: Stnith, aged 23 months. Normal at 
time of inoculation. 

,, Pec.: 21, i888r - 1.30 p. m., inoculation ; 2*45 p. m., 
tennlp. 10Q4,F., pi;lseA2o; 7 p. m., teinp..,ipo.4 F., pi^lse 

: i Dec.i 22 j 7 a. m. - Rash oyer anterior s^nd lateral surface 
of chest, pat<?liy. hut indistinct; thi:oat reddened; tonsils 
and uvula slightly swollen ; 9 a. m., temp. 100 F., pulse 
1x48; i7:pt'in;,'itemp.;ioo.8F4 pulse i44,! ^ 

Dec. 23, 9.30 a. m. Temp. 99.30 IF^^.pul^e 128; 6.59 
,p4 m^ (emp, i'06;8]F;i)ipul;5e:i44;(t;Qnsil§ ;red ^nd §lightly 
•swoUe^nil £a^^i £ajiiBt)*bwt:f airly cfiDti»w&ttp <)ji ch(^^t,.9[bdQ- 
men and arms; point of inoculation pimpled in centtre 
and elevated. 


Dec. 24, a. m. Temp. 99.2 F., pulse 128 ; p. m., temp. 
102.6 F., pulse 140 ; throat normal ; rash unchanged ; 
arm and hand swollen, although the point of inoculation 
is not tender except on pressure ; rash fading. 

Dec. 25, a. m. Temp. loi F., pulse 128; p. m., temp. 
100.4 F.; rash fading; still red on genitals and thighs, 
where desquamation is well begun ; inoculated arm hot 
and much swollen. 

Dec. 26, a. m. Temp. 99 F., pulse 112; p. m., temp. 
99.6 F., pulse 120; hand and arm less swollen; urine 
acid, copious in quantity and contains considerable pus 
and epithelium. 

Dec. 27, a. m. Temp. 98.2 F., pulse 120; p. m., temp. 
99.4 F., pulse 160; abscess at point of inoculation opened 
at 1.30 p. m., and much pus was discharged; urine normal. 
, Dec. 28, p. m. Temp. 97.2 F., pulse 128 ; rash wholly 
faded ; abscess healing ; desquamation in large plates on 

Dec. 29, a. m. Temp. 97.2 F., pulse 136; p. m., temp. 
99.2 F., pulse 124; desquamation in fine scales on chest, 
and in large flakes around point of inoculation. 

Dec. 30., a. m. Temp. 97.4 F., pulse normal ; p. m., 
temp. 98.4 F., pulse normal. 

Dec. 31, a. m. Temp. 98.4 F., pulse normal; p. m., 
temp. 98.2 F., pulse normal. After Jan. i, nothing 
occurred worthy of note, excepting between Jan. 2 and 
Jan. 9, when some pus and epithelium was found in the 
urine. Desquamation ceased about Jan. 23. 

Case 10. — George Carter, aged 3 years. Patient normal 
at time of inoculation. 

Dec. 21, 1888. 1.30 p. m., inoculation; 2.45 p. m., 
temp. 100.6. F., pulse 104; 7 p. m.^ temp. 99.2 F., pulse 

ESSAY. 209 

Dec. 22, 9 a. m. Temp. loi F., pulse 148 ; vomited 
without apparent nausea ; looks heavy ; scarlatinal rash 
apparent by daylight over trunk ; face flushed ; throat, 
tonsils and uvula distinctly red and swollen; marked 
inflammation at point of inoculation ; 2 p. m., eruption on 
legs and arms ; cervical glands a little large ; lively, but 
fretful; slight pain on swallowing ; 7 p. m., temp. 100.4 Fv 
pulse 136. 

Dec. 23, 9.30 a. m. Temp. 99.4 P., pulse 152 ; rash all 
over body, slight on face; throat normal; 6.30 p. m., 
temp. KX).4 F., pulse 136; rash brilliant red; point of 
inoculation elevated in centre ; base broad, hard and 
inflamed ; child fretful, but lively. 

Dec. 24, a. m. Temp. 99.4 F., pulse 152; p. m., temp. 
103 F., pulse 144 ; rash unchanged ; point of inoculation 
purplish red ; arm and hand swollen ; during the after- 
noon the abscess at point of inoculation broke and dis- 
charged some foul-smelling pus. 

Dec. 25, a. m. Temp. 100 F.; p. m., temp. 99.6 F., 
pulse 124 ; rash unchanged ; abscess slowly healing; hand 
and arm still much swollen ; hand beginning to desquam- 

Dec. 26, a. m. Temp. 100.2 F., pulse 132; p. m., temp. 
99.6 F., pulse 116; rash beginning to fade; hand and 
arm about normal ; rash rapidly fading later in the day ; 
desquamation around point of inoculation ; passes large 
quantity of water. 

Dec. 27, a. m. Temp. 99 F., pulse 112; p. m., temp. 
99.6 F., pulse 102 ; rash nearly gone ; abscess healing 

Dec. 28, a. m. Record of temperature not left ; p. m. 
temp. 99.4 F.; rash faded. 

Dec. 29, a. m. Temp. 98.6 F.; p. m., temp. 99.6 F.; 
desquamating on elbows. 



Dec. 30, a. m. Temp. 99.2 F.; p. m., temp. 99.6 F.; 
desquamating on trunk. 

Dec. 31, a. m. Temp. 99.6 F.; p. m., temp. 99.6 F.; 
inoculated arm desquamating much more than the other. 
After Jan i, nothing occurred worthy of note, except that 
on Jan. 4, the abscess at point of inoculation began dis- 
charging anew, and continued doing so till Jan. 12 ; the 
hands at least twice, and the process was not finally 
finished till about Feb. 10. 

Time desquamating began. 

Case I. 9 days after appearance of eruption. 




























Average time, 6.7 days; longest time, 9 days; shortest 
time, 3 days. 

Duration of period of incubation in the various cases : 
I, 12 hours; 2, 48 hours; 3, 48 hours; 4, 36 hours; 5, 

18 hours; 6,20 hours; 7, 29 hours, 30 minutes; 8,72 

hours; 9, 22 hours, 30 minutes; 10/15 hours, 30 minutes. 

Average duration of incubative period, 32 hours and 13 


Vomiting occurred as follows, as to frequency and 
time : 

Case I, vomited in 12 hours ; case 2, vomited in 12 
hours; case 3, vomited in 6 hours; case 4, vomited in 12 

ESSAY. 2 1 1 


hours; case 5, vomited in 15 hours; case 6, nausea 12 
hours, 30 minutes ; case 7, no vomiting or nausea ; case 
8, no vomiting or nausea; case 9, no vomiting or nausea ; 
case 10, vomiting in 19 hours, 30 minutes. Average 
time of vomiting, 12 hours and 50 minutes after inocula- 

Temperature range : 

Case I. Highest temperature, 102.5 F.; lowest temper- 
ature, 98 F.; average temperature. 99.37 F. 

Case 2. Highest temperature, loi^ F.; lowest temper- 
ature, 98^ F.; average temperature, 99.7 F. 

Case 3. Highest temperature, 99^^ F.; lowest temper- 
ature, 98^ F.; average temperature, 99.03 F. 

Casfe 4. Highest temperature, loi F.; lowest temper- 
ature, 98^ F.; average temperature, 99.3 F. 

Case 5. Could not get temperature. 

Case 6. Highest temperature, lOi^ F.; lowest temper- 
ature, ioo| F.; average temperature, loi.i F. 

Case 7. Highest temperature, 101.8 F.; lowest tem- 
perature 97.4 F.; average temperature, 99.6 F. 

Case 8. Highest temperature, 103 F.; lowest temper- 
ature, 97 F.; average temperature, 100 F. 

Case 9. Highest temperature, 102.6 F.; lowest temper- 
ature, 97.2 F.; average temperature, 99.3 F. 

Case 10. Highest temperature, 103 F.; lowest temper- 
ature, 98.6 F.; average temperature, 98.6 F. 

Average temperature of the 9 cases in which temper- 
ature was taken, was 99.22 F. 


1. The mucus of the throat and mouth has been 
shown with absolute certainty, to contain the contagium 
of the disease. 

2. The early eruptive stage of scarlatina is exceed- 


ingly infectious, because of the presence in the discharges 
from the mouth and throat, of the special poison of the 

3. The contagium of the disease being in the mouth 
and throat secretions, care should be taken not only to 
disinfect these parts as perfectly as possible, but to keep 
tongue, mouth and lips moist constantly, if possible, in 
order to prevent the contagious principle being forced 
into the air of the room by the exhalations of the patient. 

4. Mouth and nose wipes should be used instead of 
spit cups and costly handkerchiefs, and they should be 
destroyed hy fire before the discharges on them dry, 1. ^., 
at once. If fire be not available, use disinfecting solu- 
tions, strong enough to render inert the poison. 

5. Prevent, if possible, the soiling of the bed clothing 
and personal apparel with mouth discharges. In the 
event of such contamination, disinfect as soon as possible. 

6. No toys or implements of any sort that cannot be 
boiled or subjected to the strongest germicidal solutions 
should be given the patient, as they are apt to become 
soiled by the mouth secretions. 

7. Those who minister at the bed-side, should be 
especially careful as to person contamination and disin- 
fection, from the moment they enter the room. 

8. Take thorough care of the nostrils, as the morbific 
matter which finds its way into these parts, will, in the 
dry state, easily find its way into the atmosphere of the 
room, thus making the spread of the disease more liable. 





• ♦• 

At the room of the Secretary of the State Board of 
Health, in Trenton, a meeting of the Standing Com- 
mittee was held June 21, 1896. There were present 
Drs. Mitchell, Young, Iszard and Elmer. An organiza- 
tion was eflfected by the election of H. W. Elmer, Chair- 
man, and Henry Mitchell, Secretary. Acting under the 
new by-laws, Dr. Henry Mitchell was assigned to pre- 
pare a paper on the progress of the medical profession 
at large during the past year in State Medicine and 
Hygiene; Dr. Iszard, on Medicine and Therapeutics; 
Dr. Chas. Young, on Surgery ; Dr. Pierson, on Diseases 
of Nose and Throat ; Dr. Lamson, on Diseases of Eye 
and Ear, and Dr. Elmer on Bacteriology, to be presented 
at the next annual session of this Society. 

In April last, the Chairman sent circular letters to each 
of the reporters, announcing that no printed circulars 
would be issued this year, as has been the custom for 
some years past, but suggested to them that in their 
reports they give prominence to the meetings of their 
county societies — the number of sessions, brief summary 
of papers presented and items of interest connected with 
them. The object of this was, that collectively we 
might become better acquainted with the work of the 
individual society, that a more intimate relation might 
be established between the parent society and its con- 
tributing branches, to be informed of their progress and 
thus, if possible, to cause each district to become more 
interested and closely allied to the State Society. 
Whether the course pursued was the best, is a question 
with your chairman. The reports have not been all that 
could be desired, but perhaps if in the future the same 


plan should be pursued, a better acquaintance with it 
will give better results. 

As a rule, the reporters have responded within the 
time specified in the by-laws and seventeen counties 
have furnished reports. Following out, then, the plan 
proposed, ATLANTIC COUNTY Society holds bi-monthly 
meetings which have been well attended, particularly by 
the members residing outside of Atlantic City. Numerous 
papers have been read before the society by members 
and invited guests, on subjects of practical import. 

Within the past year, owing to the inconvenience of 
the hour of meeting of the county society, to the 
physicians of Atlantic City, the " Atlantic City Academy 
of Medicine *' has been formed, composed largely of the 
physicians of Atlantic City, who, while still retaining 
their membership in the county society, have convened 
these additional monthly meetings in the evening, for 
mutual improvement by professional and social inter- 
course, and which is already evident in a marked degree. 

Burlington. — The reporter hopes that while, as in 
some years, he is not able to record the presentation 
of any scientific investigations or specially prepared 
papers, no one will think the society is lifeless. On the 
contrary, the membership is as large, the attendance as 
good, and the interest manifested as enthusiastic as ever. 
With no papers presented, there have been interesting 
and edifying informal discussions on the medical 
advances of the day. 

Cumberland. — Within the past few years a new 
interest has been instilled into this society ; instead 
of semi-annual meetings only, quarterlies have been 
established. The April and October sessions are devoted 
to the transaction of routine business and presentation of 
papers, while those of January and July are occupied in 


the presentation and discussion of papers on scientific 
subjects. Papers on the progress of the different branches 
of medicine and surgery are presented by members 
appointed annually. To the list of membership have 
been added a number of names, and several gentlemen 
in the Philadelphia profession, of well known reputation, 
have been elected to associate membership and have 
addressed the society on subjects of special interest. 
The by-laws have been revised and are in keeping with 
those of. the State Society, and its sessions are made 
interesting by excellent papers and prompt discussions. 

Gloucester is reported as in a very flourish- 
ing condition. The meetings are held in May and 
November and successfully conducted. The attend- 
ance is good and much interest manifested by the mem- 
bers in the preparation and presentation of papers, many 
of which are given by the reporter. 

Hunterdon has semi-annual meetings in April 
and October, which are occupied by the reading of 
reports of interesting cases and essays, followed by a 
general discussion. At one of these meetings the society 
is addressed by a specialist from New York or Philadel- 
phia, on some subject connected with his branch, and for 
which the reporter claims the double benefit of keeping 
the members informed of the advances in that special 
line of practice and bringing them in contact with the 
leading men of the profession. 

Mercer holds monthly meetings, and from the 
number of papers reported as presented at each 
meeting, it would appear that considerable scientific 
study and work is being done. The annual meeting was 
held in November, followed * by a banquet. At this 
meeting Dr. S. T. K. Morton, of Philadelphia, presented 
a paper on ** Some Modern Methods pf. Skin Grafting." 


Middlesex. — ^The reporter remarks that it seems almost 
impossible to get the members of the society together until 
summoned to take action upon the death of one of their 
most efficient members, Dr. A. V. N. Baldwin, and the 
April meeting was well attended. Considerable work 
towards a reorganization of the society was accom* 
plished. New members were elected, and hope is 
expressed that the society will be extricated from the 
lethargy into which it has fallen. 

It has been said that there are two reasons why every 
medical man should connect himself with, and attend 
the meetings of, some medical society: that he may 
receive valuable information from his associates, or that 
he may impart instruction to those less favored than 
himself. Let us hope the profession of Middlesex will 
remember this, and by speedy and earnest cooperation^ 
resuscitate their society from its stagnant condition. 

Monmouth holds semi-annual meetings; that held in 
May is always at Freehold and is devoted to routine 
business, election of officers, delegates, etc., and closed 
with a banquet, while the October meeting is migratory 
as to place, and is devoted to the reading and discussion 
of papers on subjects chosen by the authors, the reading 
of the President's address, and the recital of cases of 
interest occurring in individual practices. 

Morris was never in a more prosperous condition 
than at present, with a good prospect of an increase in 
its already fair-sized membership. The meetings are 
held in May and December — the first occupied in routine 
business and the discussion of one paper, while the 
latter is devoted entirely to the discussion of at least 
two papers presented by members previously appointed 
by the President, and to verbal reports of interesting 
and unusual cases. 


Salem is reported numerically and financially small, 
but socially, very lengthy. However, with the addition 
of a number of new members, a more interesting and 
brighter future is predicted. We think they have 
adopted a good feature in this society — the regular 
interchange of visits from members of adjoining county 
societies — sl feature well calculated to promote enlarged 
views and pleasant relations. 

Somerset. — Meetings are held quarterly, in January, 
April, July and October, at each of which, papers are 
read and the discussion upon them opened by a member 
previously appointed. New members are being added 
and continued interest manifested. 

Sussex. — But one meeting — in April — is reported, at 
which an interesting paper on typhoid fever, by the 
President, Dr. Voorhees, was read. 

Union. — Four interesting and well-attended sessions 
are held, and the reporter mentions the papers which 
have been presented. 

Warren. — The annual meeting was held in Belvidere, 
June 8th, with good attendance ; and an enthusiastic 
good feeling is reported as existing in the Society. 

While the reports concerning ** matters medical " are 
not so profuse or extended as when the printed blanks 
were distributed, yet from them we gain a very good 
idea of the health of our State during the past year. 
The usual eruptive and infantile disease, measles, scarlet 
fever, rotheln, are reported in many of the counties. 
Nothing of special importance is mentioned in connection 
with them. 

La grippe has also made its annual appearance, gener- 
ally in a mild form, but frequently fatal in its attacks 
upon the aged, and interesting in its sequelae. We have 


come to regard it as our annual, if not perennial visitor; 
at times to be treated with indifference, and again, as 
pur formidable enemy. 

Diphtheria is very generally reported, and again anti- 
toxin has its advocates and its less readily convinced 
opponents, but its use is looked upon with growing 
favor by a larger majority of the profession. In Cam- 
den, Dr. Godfrey treated a large number of cases with 
a solution of the mercuric bichloride, administered in- 
ternally and applied locally, and found no occasion to 
use antitoxin, except in cases of laryngeal or nasal 
invasion, and this occurred in no case where the bi- 
chloride solution had been early used. He also speaks 
highly of this treatment in connection with bichloride 
baths in the treatment of scarlet fever.* 

Dr. Ridge had no occasion to use antitoxin in the 
treatment of the cases he met with. Dr. Braymer still 
treats his cases as reported last year, and Dr. Benjamin 
pursues the treatment advocated before the last session 
of this Society. The physicians of Gloucester County 
are impressed with its usefulness, and happy results have 
followed its administration. The health officer of 
Trenton, Dr. McGalliard, gives the statistics from the 
cases of diphtheria in that city, that the mortality with 
the use of antitoxin was lo per cent., against 32 per 

cent, without. 

Dr. Weeks, in an address before the Mercer County 
Society, on ** Observations Upon Foreign Hospitals," is 
reported as saying that in the Wilhelmina Hospital, 
Amsterdam, antitoxin had been abandoned and trache- 
otomy substituted for intubation. 

In Middlesex, antitoxin is regarded with more favor 
than last year. The experience of the physicians of 
Monmouth County has been favorable to its early use, 
resulting in no harm and probably saved many lives. 


In Union County, diphtheria has prevailed to quite a 
degree. The adherents of antitoxin claim excellent 
results, while others claim that the epidemic was of mild 
character. In Phillipsburg, Warren County, 137 cases 
were reported, in 80 per cent, of which antitoxin was 
used>, and the mortality shown is 10. Dr. Stites reports 
two deaths during convalescence, from cardiac failure. 

Typhoid fever, as usual, is quite generally reported. 
In Camden an unusually large number of cases is 
reported, but of an unusually mild type, which is 
accounted for by the fact that the water supplied is of so 
much better character than formerly. Dr. Romain has 
read a preliminary paper before the Hunterdon County 
Society upon the epidemic occurring in Lambertville, 
among the employees in the rubber mills, accompanied 
with a high death-rate. No particulars are given, but we 
hope the paper will be considered of sufficient importance 
to appear in the Transactions. The increase in the 
number of cases in Quinton, Salem County, is accounted 
for by the low condition of the wells during the winter 
months. Dr. Mecray endorses the Widal test for 
diagnosis, but we regret that no mention is made of 
the Woodbridge treatment by any one. 

The malarias are but sparingly reported, but Dr. 
Stephenson, of Haddonfield^ reports two cases illustrat- 
ing the fact that malarial germs may be carried in the 
system for a long time with occasional outbreaks. In 
one case, the six weeks infant of such a mother, 
suffered with a fever, which was relieved only by quinine. 
In another, the new-born child failed to thrive until 
placed under anti-periodic treatment. 

Pertussis has prevailed in every county in the State 
with the exception of Sussex, but few items of interest are 
mentioned in connection with it, and with the exception 


of Burlington and Warren, no mention of treatment is 
made. These report successes with phenacetine, bella- 
donna, hippocastanum and bromoform. Pneumonia, of 
an infectious type, has existed in Salem County — mem- 
bers of the same family being attacked seriatim. 

Sanitation. — Several counties testify to the con- 
tinued and renewed activity of boards of health, more 
intelligent administration, more zealous and effective 
labors. The reporter for Atlantic County presents a very 
interesting record of the health of the county, and par- 
ticularly of Atlantic City. He gives its mortality as 6.1 
per thousand, a record possessed by no other health resort 
in America, and approached only by that of Los Angeles 
and Ashtabula, whose mortality is 12 per thousand. 

In Camden City the improved condition of the drink- 
ing water, as furnished from artesian wells, is marked, 
and as before stated, the mild character of the cases of 
typhoid fever is thought to be attributable to this. A 
board of health has been organized in Stockton, the 
main street graded and macadamized, and a system of 
sewerage agitated. Hudson County exhibits a remarkable 
improvement in its hygienic conditions, and considers 
the gain in its death-rate of 22.7 per 1,000 this year, 
against 25.7 in 1,000, as reported last year, worthy of 
note, when consideration is given of the fact that twenty 
public institutions, including the Soldiers' Home at 
Kearny, exist within her boundaries ; that many railroad 
trains and trolley cars traverse her territory, and the oft- 
complained-of pestilential heaps still remain, in spite of 
repeated efforts to have them removed. The intro- 
duction of the Pequannock water throughout the county 
has been of great . benefit, and since its distribution no 
cases of typhoid fever have been reported. 



The Mercer County Society, in conjunction with the 
Board of Health, is agitating the question of a filtration 
plant for Trenton. The condition of some of the 
smaller towns in Union County has been much improved 
by the introduction of sewerage systems, but Elizabeth 
has not yet been able to perfect the trunk sewer which 
has been under consideration, and so strongly advocated. 
A well-equipped contagion hospital has been completed. 

A brief summary of a number of interesting cases 
-will be found in the reports from the various district 
societies, as well as interesting cases in detail. 

Papers. — But few original papers have been received, 
and are : " The External Treatment of Pneumonia," by 
Dr. Eugene Way, of Cape May ; **A Unique Case With 
Obscure Symptoms," by Dr. L. Farrow, of Morris ; ** A 
Report of the Treatment of Diphtheria in a Child of 
Five Months, by Antitoxin," by Dr. Stokes, of Bur- 
lington; "Cases of Asphyxia," by Dr. Kyte, of Hudson. 

Institutions. — Cooper Hospital reports the treatment 
of 616 patients during the past year, and 10,138 have 
been treated in the Camden City Dispensary. Sixteen 
graduates obtained diplomas from the Training School 
for Nurses, at the commencement held June 3, 1897, and 
at which Dr. O. W. Braymer delivered the address. 

Necrology. — Since our last meeting the following 
members have been taken from our ranks : 

Bergen County. — J. M. Simpson, M.D., June 11, 1896. 

Camden County. — Thomas Garwood Rowand, M.D., 
of Camden, January 25, 1897. 

Cumberland County. — Charles R. Wiley, M.D., of 
Vineland, April 2, 1897. 


Hunterdon County. — William R. Little, M.D., of 
Bloomsburg, Feb. 13, 1897. 

Mercer County. — John Kirby, M.D., of Trenton, Feb. 
27, 1897. 

Middlesex County. — A. Van Nest Baldwin, M.D., of 
New Brunswick, February 14, 1897. 

Somerset County. — Isaac L. Compton, M.D., of Bound 
Brook, April 5, 1897. 

Union County. — W. K. Gray, M.D., of East Orange, 
July 7, 1896; D. E. Decker, M.D., of Woodbridge, July 
20, 1896. 

In closing this report, pardon me if I again urge upon 
reporters the second suggestion contained in the report 
of the Standing Committee for 1896, "that they make it 
their duty to keep fully posted in the medical history of 
their counties throughout the year, and not postpone till 
within two months of the annual meeting of this Society, 
collecting material with which to furnish the Standing 
Committee a report,** and to commend most earnestly to 
each individual member of this Society, the closing 
sentence in the report from Hudson, "that although the 
task of reporting cases is gratuitous, and to the careless 
observer may seem thankless, yet one of the chief aims 
of our profession, that of relieving distressed humanity, 
is as well observed by the dissemination of knowledge of 
the progress and improvement in the science, as by 
direct attendance upon the individual cases. 

Respectfully submitted, 





Progress in State Medicine and Hygiene. 

Under the provision of the new bylaws of this Society, it 
becomes the duty of each of the members of the Standing 
Committee to prepare and present a paper on the progress, 
<iurmg the preceding year, in some one of the departments 
of medicine, and to me has been allotted the subject of public 

To bring the most important topics embraced within the 
limits of medicine and surgery in review at each annual 
meeting, promises to become attractive and useful to the 
members of the profession throughout the State, in proportion 
to the brevity with which each subject can be presented, and 
it is my aim at this time to merely outline the advances which 
have been recently made in the branch which I have the honor 
to bring before you. 

Scientific investigation has never been more industriously 
pursued than during the past year, and a great store of new 
facts has been dug from the mines of wealth within the drain 
of hygiene. Bacteriology has continued to yield up her 
treasures in response to patient and painstaking study, and 
labor in this department has been more highly rewarded than 
in any other. 

It seems to have been demonstrated that protective inocu- 
lations are destined to be successfully applied in many, if not 
in all, germ diseases. The immunity secured against rinder- 
pest by Koch during his investigation in South Africa, follow- 
ing closely upon the firm establishment of the value of 
antitoxin serum in diphtheria, has stimulated every laboriatory 
worker to renewed exertion, and additional grand achieve- 



ments in this direction will doubtless occur. The bacteriology 
of vaccine is still being worked out, and Drs. Klein and 
Copeman appear to have recently discovered certain small 
bacilli, both in vaccine and variolous lymph, which they think 
will prove to be the true cause of small-pox. 

The typhoid bacilli, though it has continued to be regarded 
as the essential cause of enteric fever, has not yet been found 
capable of inducing that disease experimentally. The 
diagnosis of typhoid fever by observing the reaction attending 
the addition of the serum of the blood from a typhoid patient, 
to a pure culture of the typhoid bacillus, has attracted much 
attention, and it probably will become' a reliable method of 
confirming clinical indications of the presence of this disease, 
although its employment has not thus far given results with 
sufficient uniformity to insure confidence. 

The investigations of the English Local Government Board 
concerning oysters, in their relation to outbreaks of infectious 
diseases, show that the typhoid bacillus and the cholera 
vibrio may live in sea water for two or more weeks, and that 
oysters from sources exposed to sewage contamination, were, 
in some instances, found to contain cholera bacilli. These 
inquiries may be regarded as confirmatory of the view long 
entertained, that oysters and other shell- fish which are taken 
from beds polluted with sewage, may convey typhoid fever 
and cholera. Sanitary supervision should therefore be ex- 
tended to the oyster industry, and the sale of oysters which are 
collected from sewage polluted waters or which are stored in 
such waters, should be prohibited. 

The introduction of formaldehyde as a disinfectant has 
been attended by a revival of interest among sanitarians, con- 
cerning methods to be employed in purifying premises when 
infectious disease has occurred, and the use of test cultures 
as a check on the disinfecting processes has rendered it possi- 
ble for health officers to prove their work, and to demonstrate 
the degree of efficiency which is attained in each case where 
the cleansing of apartments is undertaken. The use of steam 

1>AP£R. 227 

in a properly constructed sterilizing chamber will probably 
never be supplanted as an effectual and satisfactory germicide, 
but the application of steam, and also the immersion of 
infected articles for a suitable time in boiling water is often 
impracticable. The employment of germicidal solutions is 
also limited in its application. The use of the formalde- 
hyde, a non-poisonous gaseous substance, capable of destroy- 
ing the pathogenic bacteria with great certainty, has therefore 
been warmly welcomed, and its use is extending with remark- 
able rapidity. 

A novel device for the purification of sewage has been 
brought to public notice during the year by M. D. Cameron, 
City Surveyor of Exeter, England. It is described as follows: 
The method is known as the " Septic Tank System *' for the 
treatment of sewage. The raw sewage flows into the tank, 
from which all light and air is excluded to favor the develop- 
ment of the putrefactive organisms which are believed to be 
the cause of the rapid changes which follow. The fermenta- 
tion which occurs in the sewage causes the suspended organic 
matters to be thrown into solution. The overflow from the 
tank is said t© be odorless and comparatively clear. The 
effluent is still further treated by passing it through coke 
breeze filters, and the discharge is said to be clear, sparkling 
and without smell. 

The profession is aware that the mortality among infants 
during the summer of 1896 was unusually small in the cities 
of this State, and the commonly accepted explanation of this 
fact is that many mothers and nurses have learned the value 
of Pasteurization in preparing milk. In the light of the 
knowledge now so generally disseminated concerning the 
danger attending the administration of raw milk to young 
children, there is reason to expect that the infant mortality 
will be still further diminished. 

Applied hygiene has in no direction made more gratifying 
progress than in the medical supervision of schools. In 
Boston, the sanitary authorities were led several years ago to 


cause a daily medical inspection of pupils and teachers in 
public schools to be made to check the spread of diphtheria, 
and the results were so satisfactory that the measure was 
adopted as a part of the regular system employed by the city 
for the promotion and protection of the public health. New 
York City has recently adopted a similar method, and the 
inquiries already made show the very great value of this 
branch of the service. 

.The report of the medical inspectors of schools for one 
week shews that 4,599 pupils were examined, and that 943 
children were excluded from school attendance. There was 
found to be 4 cases of measles, 4 of diphtheria, i of scarlet 
fever, 2 of croup, 13 of mumps, 8 of chicken-pox, 28 cases of 
contagious eye diseases, 160 cases of parasitic diseases of the 
head and body, and 13 of skin diseases. 

If there were cooperation between the boards of education 
and the boards of health, medical inspection of schools could 
be instituted throughout New Jersey without additional legis- 

The closing of public schools is very undesirable, and it 
cannot readily be resorted to as a means of preventing the 
spread of infectious diseases, except in outbreaks of unusual 
severity, and it is improbable that it would be necessary, 
under any circumstances, if to medical inspection of the 
pupils could be added a thorough system of purification of 
school buildings, school furniture and school books. 

The international sanitary conference held in Venice during 
February and March, 1897, to consider more effective meas- 
ures for the prevention of the introduction of cholera from 
(ndia and other eastern countries, marks another progressive 
step in the improvement of the prophylactic methods of deal- 
ing with the pestilential diseases of our times. Since 185 1, 
the date of the first international sanitary conference, there 
has been a. gradual yielding to the views advanced ; health 
officers to substitute inspection, isolation of the sick and dis- 
ipfection of infected persons and property, for long and 

PAPER. 229 

vexatious quarantine detention in the case of vessels from 
infected ports, and to deal entirely with the vessel, its pas- 
sengers, crew and cargo, instead of the port of departure. 
Commercial interests have always dominated in matters relat- 
ing to maritime quarantine, and it was the necessities of trade 
which led to the earliest attempts in Europe to prevent the 
spread of infectious diseases. 

In the twelfth century, the republic of Venice, after being 
repeatedly invaded by devastating epidemics, organized a 
system of inspection and detention in the case of vessels 
arriving from the ports of' Asia, and established a lazaretto to 
which all infected passengers, crew and cargo were committed. 
From this beginning was developed, by slow degrees, the 
maritime quarantine which has prevailed throughout the 
western hemisphere for five hundred years. 

To modify the unnecessary and harassing features of quar- 
antine restrictions as rapidly as advancing knowledge of the 
origin of the communicable diseases will permit, is the natural 
tendency of commercial interests. The practice at the port 
of New York has kept pace with the best service abroad, and 
the ' facilities for the cleansing of infected passengers and 
^^ggsge ^re unsurpassed. 

Measles has received considerable attention at the hands of 
health officers during the past year, because of varying views 
in regard to the advisability of attempting to control the 
spread of this disease. Hitherto, measles has evaded the 
isolation restrictions which have been fount! sufficient for the 
suppression of outbreaks of scarlet fever and diphtheria, and 
it has appeared with exasperating regularity as an epidemic in 
all parts of America about every third or fourth year — as often 
as a new generation of susceptible individuals has been 
' Unquestionably, the spread of this disease can be wholly 
prevented if absolute isolation is obtained for the first cases 
in a community, but the difficulties in the way of this accom- 
plishment seem to be almost unsurmountable, for measles is 


exceedingly infectious in its pre-eruptive stage, and this 
circumstance leads to the exposure of persons capable of 
taking the affection, before the disease is recognized by the 
parents, and before any physician has seen the patient. 

Measures for the prevention of tuberculosis are being 
actively discussed in every community, and the Board of 
Health of the City of New York has led the way by placing 
pulmonary tuberculosis among the notifiable diseases. In 
New Jersey the application of the measures which have proved 
to be useful for preventing the spread of infectious diseases, 
has been gradually extending, but the public demand for pro- 
gressive and efficient sanitary administration is in advance of 
the action which is at present being taken by the constituted 
sanitary authorities. 

This relation between health boards and citizens is in 
strong contrast with the conditions which existed until a few 
years ago, and it is believed that official inactivity is mainly 
due to the inadequate supply of trained employees. It is a 
curious fact that while instruction is provided for almost every 
other profession, art and trade, yet no training has thus far 
been furnished, neither by the State nor by private enterprise, 
for sanitary officers, and boards of health are obliged to 
entrust the enforcement of health laws and ordinances to 
unskilled persons. 

The Medical Society of New Jersey has led in many good 
works during the past 130 years. Why not effect reform in 
the method of selection and in the education of health 
inspectors? Only last year this Society took action which 
resulted in placing upon a permanent basis the State bacteri- 
ological laboratory, and without doubt its influence and 
resources would, if exerted, establish in our State a system 
for the training of officers which would give us a class of men 
who would be capable of intelligently applying the arts of 
hygiene which are now being promulgated with almost daily 



Aphorisms on Medico-Legal Testimony. 

' In view of the fact that the American Medical Society has 
just closed its session in Philadelphia — and perhaps the 
largest and most interesting session ever held, and where so 
much was said and written about medicine and therapeutics 
{the subject assigned me for a paper before this Society)^ 
I have taken the responsibility of changing the title and 
isubject, and will give you a few thoughts on a subject that has, 
does now, or will in the future, practically and personally 
interest every member of the profession — the general practi- 
tioner, the surgeon and the specialists, viz.: Medico-Legal 
or Expert Testimony. 

I shall be brief in what I have to say and will only endeavor 
to freshen your memories on a few salient points in medico- 
legal practice. The word expert in medicine is defined as 
meaning a man of skill and experience — expert witness, one 
whose opinion in medico-legal cases is valuable from his 
accurate knowledge of the subject under consideration. 
Expert in law is defined as one who is experienced, skillful, 
or having peculiar knowledge on certain subjects or in certain 
professions ; in other words, a scientific witness. 

The word testimony is perhaps used more frequently in the 
Bible by biblical writers than either in medicine or in law. 
In both the latter it is defified as evidence of a witness or 
witnesses under oath or affirmation. In this connection and 
without further quotations, I would discuss the subject from 
the standpoint that all medical testimony is, in a qualified 
sense, expert testimony. That which is usually denominated 
by that term is practically corroborative testimony. 


Many lawyers object to or condemn expert testimony, 
because the so-called experts sometimes differ in their opinions 
and statements, and will endeavor to~ break down the testi- 
mony of good medical men because of this fact. I am obliged 
to admit that medical men do often differ in their opinions, 
and we frequently find them backing their opinions in heated 
and very animated discussions, especially on the subject of 
the causation of disease. To illustrate, take typhoid fever and 

Should some person or persons institute legal proceedings 
against a city or corporation for supplying unhealthy water, 
that to their minds brought fever and death into their family, 
you would find medical men subpoenaed to go before the court 
and jury and there give evidence that to their knowledge, as 
scientific men, the water does contain the specified germs that 
produce the fever, and with . long and profound reasoning, 
would so impress the court and jury that the water was full of 
these health-destroying and death-producing elements. 

Before the same court and jury the defendant would bring 
medical or scientific testimony that would prove to said court 
and jury just the contrary, viz.: That the germs found in the 
excreta or in the viscera at post-mortem, were the effect and 
not the cause of the disease. The witness for the defendant 
is equally honest, sincere and positive in his belief and declar- 
ations. Hence, it is not so much a wonder that lawyers, who 
are not schooled in medical science or medico-legal jurispru- 
dence (and it is an astonishing fact that there are but very few 
who are) should attempt to poison and prejudice the minds 
of a jury against the reliability of medical testimony. 

Take the subject of insanity : Hamilton, in describing 
the duties of the medical expert, says, especially on the 
question of insanity, " whether in civil or criminal cases, we 
are to determine the influences that may destroy the responsi- 
bility of an individual, and it should always be borne in mind 
that the offices of the physician are only those in which he is 
warranted in forming an opinion relative to the enfeeblement 


af mind through disease. Questions of law do not concern 
him and the courts will not permit him to express more than 
what he knows regarding the medical aspect of the case. 

"He should always remember the dignity of his calling, 
and never lose his temper, no matter how much galled he may 
be by the impertinence of the opposing counsel, who is not 
always a gentleman. He should never be flurried, never give 
hurried answers, and should demand the time for his full 
answer if attempted to be choked off or interrupted. He 
should, on the other hand, never show an eagerness to testify 
or too much enthusiasm in espousing the cause of the side on 
which he may be employed. His testimony should be given in 
a cool, impartial manner. He should be on the alert and 
avoid the possibility of being trapped by his ingenious legal 

**A favorite method of some lawyers is to dissect a hypotheti- 
cal question and demand answers to isolated portions. By 
this means it is possible to get a truthful negative answer to 
many of the elements of real insanity. For instance, do you 
consider the fact that a man that is slovenly or careless in his 
habits an infallible sign of insanity ? may be asked, and the 
witness of course answers no, while this very untidiness or 
slovenly habit, taken with other indications, may be a very 
important element of the mental disease. 

** The medical man should therefore be on his guard and 
refuse in such cases to give anything but a qualified answer. 
Remembering that all manner of dodges may be resorted to — 
instance further, such as asking the witness if he has read such 
and such authorities ? while in reality no such works are in 
existence. He should therefore avoid being drawn into dis- 
cussions upon various other subjects which are foreign to the 
case in hand, and if the abstract questions be not strictly 
medical, the witness may very properly refuse to answer, at 
least so far as he may be made or asked to pose as an expert 
in some other field. 
* " It is not always wise to pose as a radical or as a person of 


more than ordinary ability, and therefore you should not 
puncture your answers with anything extraneous. The witness 
who declares himself an agnostic is very apt to injure his case 
and render himself ridiculous. So, too, he is not warranted in 
ventilating before a jury any extreme views that he cannot 
maintain or prove. The flippant witness is very sure to 
impair his case by trying to raise a laugh or by an attempt at 
repartee, for he may find, to his cost and chagrin, that some 
sober old lawyer has been quietly listening and biding his 
time to turn the laugh upon the expert, and will create in the 
minds of the jury an opinion that is not very complimentary 
to such expert and prejudicial and injurious to his side of 
the case. In other words, a thoughtless answer may destroy 
the weight of all the sound testimony that may have been 
given before." 

Hence, gentlemen, if you are ever called to testify before a 
court and jury, and you surely will sooner or later, and as 
many of you have, you should keep these facts before you. 
Never attempt to give any information except what is 
absolutely demanded. Never attempt to explain or enlarge 
upon something you known practically nothing about. 

You may be able to theorize, but before a court of justice 
you must know practically what you are saying. If called as 
an expert your theory amounts to very little. You can't 
swear by theory. The stenographer is noting your testimony; 
every word is on record. You may not have heard the 
evidence given by your professional brother in the same case, 
and before the same jury, and when the testimony is read by 
the stenographer before the court and before the jury, it would, 
to say the least, not be very complimentary, either to the 
witness or to the profession, if on some vital or material point 
it should be found that such evidence was absolutely contra- 

Hence the lesson — be on your guard. If a doubt crosses 
your mind let your answers or evidence always, so far as 
possible or permissible by the court, be given in a qualified 

PAPER, 235 

sense. There seems to be a growing sentiment in favor of 
judicially appointed medical and chemical experts. Dr. Chas. 
G. Garrison, an honorary member of the Camden District 
Medical Society, and, at present, one of the supreme court 
judges, read a paper from the medico-legal section before 
that society in 1884, in which he showed the need of medical 
experts being called by the court instead of by the counsel. 
Hefbelieved it would do away with the apparent discrepancies 
between medical experts, due to answers to hypothetical cases 
proposed by counsel. A bill has been introduced in the 
Minnesota Legislature, and one is being prepared for introduc- 
tion in the New York Legislature bearing upon this subject. 
The central idea is that expert witnesses must be all judici- 
ally selected and properly qualified, and not depend for their 
remuneration on one side or the other. 

I am persuaded that this would be an improvement to the 
present system, where medical men will hire themselves to 
testify in criminal cases more to suit counsel than to unfold 
the truth. 




Progress in Bacteriology During the Past Year.. 

Bacteriology, as befits the youngest member of the great 
family of the medical sciences, has advanced with the greatest 
rapidity, encroaching upon all the other branches of medicine, 
until today, though barely twenty years old, it is so far-reach- 
ing and comprehensive, and involves so many details, that it is- 
almost impossible for one man to be so familiar with the entire 
subject as to make him an authority on all points connected 
with it. While one may style one's self a bacteriologist, it is- 
necessary to devote one's self to some particular branch of the 
subject to become a bacteriological specialist, as it were. In 
attempting to review the progress made during the past year^ 
it will be well to first consider just what comes under the 
head of bacteriology and what are its most important branches. 

The laboratory bacteriologist, pure and simple, devotes him- 
self or herself, as many of our best workers are women, to the 
study of the morphology of micro-organisms — their modes of 
growth, their effects upon the animal organism, and so on» 
Bacteriological chemistry, the study of the various substances 
produced by or under the influence of micro-organisms, has 
become a separate and important branch of physiological 

The question of immunization and the study of the various 
antitoxines, their preparation and action, is another important 
branch of the subject. The application of laboratory results 
to practical purposes is another wide field, and where such 
application requires a knowledge of bacteriology, may surely 

PAPER. 237 

he considered as a branch of the subject. Under this head 
-come disinfection and sterilization, routine diagnosis of 
•diphtheria, tuberculosis, typhoid, etc., from specimens furnished 
by the busy practitioner, the proper administration of* the 
various antitoxines, and so on. 

In New York we are fortunate in having a progressive 
iiealth department, eager and willing to meet the laboratory 
-worker half-way, and prove or disprove the value of methods 
of prophylaxis, diagnosis or treatment which have suggested 
themselves to the bacteriologist and which he has tested, as far 
-as possible, in the laboratory. 

I hav« merely touched upon a few of the more important 
branches of bacteriology ; others will readily suggest them- 
-selves to every one. In reviewing the great mass of work 
that has been done during the past year, it is difficult to 
-determine just what will strike the average medical man as 
true progress, and what will be considered as side issues. To 
^the worker in each branch, all the original work done on his 
-own subject indicates the greatest progress, while to the old- 
nschool practitioner, like the old doctor in "Around the Red 
Lamp," the whole business is moonshine. What we must do 
is to preserve a happy medium. 

The most important work of the year to the practitioner, 
iias been done in connection with typhoid fever. I refer to 
the Widal serum test. This can hardly be considered a new 
•discovery but rather as a new application of previously known 
facts. For the past year the New York Health Department 
iias been making the test for all physicians who desired it* 
Having access to the records, and being associated with the 
work, I can perhaps point out certain facts not generally 
Icnown, especially with reference to the limitations of the test. 

As you know, the test or reaction is based upon two facts: 
first, that the typhoid bacillus is actively motile, and second, 
that the blood serum of individuals who have had typhoid 
fever contains certain substances which kill and agglutinate 
the bacilli. The ideal reaction is as follows: A drop of a 


twenty-four hours* old broth culture of virulent typhoid 
bacilli is mixed with a drop of diluted serum from the blood 
of a case of typhoid fever upon a cover glass, and this 
is inverted over a hollow slide and placed under the micro- 
scope. After a short period of time the bacilli will be seen 
to have lost their motility and to have gathered together into 
clumps and masses. A control slide made from the broth 
culture of the typhoid bacillus alone, without the serum, will 
show the bacilli in active, darting movement for hours. 

Two modifications of the above process have been intro- 
duced. It has been found that a drop of blood from a 
case of typhoid fever can be allowed to dry upon a slide, and 
that after a considerable period of time, if it be rubbed up 
with water, a drop of this will give the reaction with the 
typhoid culture. So that physicians can send the dried blood 
by mail to the laboratory, a large quantity thus being unneces- 
sary. Another modification is the using of larger quantities 
of serum and culture in a test tube ; the reaction is here 
indicated by the clumps and masses of agglutinated bacilli 
falling to the bottom of the tube. It will be recognized at 
once that this reaction, if specific, is of value not only in the 
diagnosis of typhoid fever, but also in the identification of 
the typhoid bacillus. 

The mountain in our path in the bacteriology of typhoid 
fever, is the great similarity between the typhoid bacillus and 
the so-called colon bacillus, a constant denizen of the intes- 
tinal tract and the cause of the majority of the suppurative 
conditions of the abdominal . cavity. Some observers still 
hold the two to be identical, but the weight of evidence is to 
the effect that they are entirely distinct. They resemble each 
other markedly in modes of growth and general appearance, 
and it requires a skilled bacteriologist to differentiate them. 
Such differentiation is most important in order to determine 
whether a given water is fit for drinking purposes, or whether 
it is the source of infection in an epidemic of typhoid fever. 
Here the Widal test, if specific, would prove of the greatest 

PAPER. 239 

value, as the typhoid serum would have no effect upon the 
colon bacillus. But is it a specific test, and what do we mean 
by the term ? In order to be so, it must fulfill the following 
conditions: First — The typhoid bacilli must be unaffected by 
any other serum but that from a case of typhoid lever. 
Second — They should always be killed and agglutinated by 
typhoid serum. Third — The serum from all cases of typhoid 
fever should affect the typhoid bacilli, and those alone; not 
the colon bacillus nor the cholera vibrio, for instance. 

The first postulate holds good with certain restrictions, 
based upon the degree of dilution of the serum. It has been 
found that where the dilution was as low as one to ten, that 
normal blood serum, or serum from non-typhoid cases, some- 
times gave the reaction. Dr. Guerard, of the New York 
Health Department, has collected all the cases reported, and 
has kindly allowed me the use of his figures. He finds that 
the serum of 4J per cent, of non-typhoid cases gave the 
typical Widal reaction. But it has been found that when the 
serum is more highly diluted (i to 30 or i to 50), only typhoid 
serum has any effect upon the typhoid bacillus. 

The second postulate, as to the bacilli being always affected 
by typhoid serum, brings in the question of duration of the 
disease. Guerard finds that out of 1,700 reported cases of 
typhoid fever, only 2^ per cent, failed to give the reaction. 
It has been found that the time . of first appearance of the 
reaction varies from the second to the sixtieth day of the 
disease'; as a rule it appears about the end of the first week. 
The time of disappearance varies widely. It has been known 
to be present as long as thirty years after an attack of typhoid, 
as well as to disappear after only four days* duration. These 
facts show that there are two sources of error to be guarded 
against. First — A negative result may not be decisive, as the 
reaction may not appear until late in the disease, as shown by 
the case in which it did not appear until the sixtieth day, or 
it may have been present and already disappeared. Second — 
A positive result may mean only a past case. A case of 


miliary tuberculosis, simulating typhoid fever, may give the 
reaction, the patient having had typhoid some years pre- 

The third postulate, as to the typhoid. bacillus being the 
only organism affected by the typhoid serum, is true, with the 
same restrictions as to degree of dilution as were mentioned 
above. Typhoid serum, diluted i to lo, sometimes kills and 
agglutinates the colon bacillus. A higher dilution (i to 50) 
has no effect upon it. So that, in conclusion, we can say 
that the test is a valuable one, if a proper consideration of 
the sources of error be kept in mind. But it is not abso- 
'lutely specific, and is a quantitative rather than a qualita- 
tive test. 

Much work has been done during the past year in attempt- 
ing to produce a typhoid antitoxin, by rendering animals 
immune to the action of the bacillus, and using their serum as 
in the case of diphtheria. Good results, as well as negative 
and unfavorable ones, have been reported, and further inves- 
tigation of the subject is necessary. 

The indefatigable Robert Koch, who may be considered 
the father of modern bacteriology, has maintained his position 
during the past year. 'He investigated the subject of the 
rinderpest, a very destructive disease of cattle in South 
Africa, and while he was unable to discover the cause, he 
determined the mode of \nfection, and found that animals 
could be rendered immune against the disease in one of two 
ways. Animals injected with a mixture of serum from an 
animal that had the disease and recovered, and blood from an 
animal that had died from it, were rendered immune to ten 
thousand times the fatal dose of virulent blood. The bile of 
animals dead of the disease possesses the same immunizing 
powers. Such immunity is persistent, so tha-t it seems possible 
to stamp out this disease, which annually destroys thousands 
of cattle. 

Koch has also done some work on tuberculin which 
promises to be of the greatest value. . The old tuberculin 

PAPER. 241 

contained dead bacilli. These gave rise to abscesses, as they 
were not absorbed by the body, and did pot bring about 
immunization. Koch found this to be due to the presence in 
the bacilli of certain highly resistent bodies resembling the 
fatty acids. These formed an external layer a^round the 
bacillus, protecting it from external agencies. The character- 
istic staining reaction of the tubercle bacillus is due to these 
bodies. If a perfectly dry culture of young, virulent tubercle 
bacilli be rubbed up in an agate mortar, mixed with water, 
and the sediment treated in the same way repeatedly, a solu- 
tion is finally obtained which gives no sediment. This, Koch 
calls T. R., and he claims that it possesses marked immunizing 
properties. It never produces abscesses, and while in large 
doses it produces the same reaction that ordinary tuberculin 
does, aninials can be rendered immune without showing any 
reaction whatever. Animals rendered immune by this sub- 
stance have received repeated injections of virulent tubercle 
bacilli and months afterwards have shown no evidence of 

Koch has used this new preparation in a number of cases 
of pulmonary tuberculosis and lupus, and the results have 
been far more favorable than any previously obtained with 
ordinary tuberculin. He does not claim them to be cured, 
however, as the time of observation has been too short. 
Cases that are far advanced, and cases in which the organisms 
of suppuration have the upper hand, are, of course, not 
benefited by the use of this substance. 

Little new work has apparently been done in diphtheria. 
But, in reality, much has been accomplished in the way of 
improving the diphtheria antitoxin and in extending its use. 
When diphtheria antitoxin was first introduced, its production 
was a long and tedious process, weeks being consumed in 
preparing the toxins with which to inject the horses and in 
rendering the horses immune. It is now possible to prepare 
powerful toxins in a relatively short space of time, and the 



period of immunization has also been lessened. For instance, 
it has been found that if horses are first injected with the 
antitoxic serum before beginning the injections of diphtheria 
toxin, they can stand much higher doses and are rendered 
immune much more quickly. 

The work of several observers during the past year goes to 
show that the untoward effects of the serum treatment of 
diphtheria are due mainly to the introduction of foreign serum 
into the system. This has been partly overcome by the use 
of much stronger serums, thus allowing the use of much 
smaller quantities. The ideal procedure would be to obtain 
the antitoxic substances in a pure, dry state, dissolving them 
in sterilized water, as used. Much work has been done along 
this line, the serum being evaporated in sulphuric acid exsic- 
cators, as the antitoxic substances are destroyed by excessive 
heat. The dried antitoxin has been used in the Willard 
Parker Hospital by the New York Health Department and is 
apparently as efficacious as the serum. Whether it is as 
durable and permanent has not yet been determined, nor has 
an entirely satisfactory method of preparation been worked 
out, several loopholes for contamination being still left open. 

The dried antitoxin makes up well into grayish tablets, 
which dissolve in water with very little residue. These have 
not as yet been tested. Some valuable negative work has 
been done. The production of diphtheria antitoxin by elec- 
trolysis is now known to be really a production of weak 
toxins which bring about immunity in the usual manner. 

The cholera vibrio, being motile, should react to serum 
from cholera patients as the typhoid bacillus does to typhoid 
serum in the Widal reaction. While this holds good, the 
reaction is not as specific as the Widal reaction, and certain 
water ^pirillae give the Pfeiffer reaction, as it is called, as well 
as the cholera vibrio. Attempts have been made to isolate 
and identify the specific substances which have this dissolving 
and agglutinating action in the serum of animals immune 
against cholera, and while these attemps have not been 

PAPER. 243 

entirely successful, it is probable that these bodies are of the 
nature of enzymes. Haffkine's exhaustive work on protective 
inoculations against cholera has been confirmed by several 
observers, all of whom agree as to the great value of the 

As the conditions known as sepsis, including septicaemia 
and septico-pyaemia, are, as a rule, due to the streptococcus 
pyogenes, many workers have devoted themselves to confirm- 
ing and extending our knowledge of the properties and use of 
Marmovek*s anti-streptococcus serum. Positive results have 
been achieved in animal experiments, but so far, the results of 
its use in erysipelas, puerperal fever and similar conditions 
have not been encouraging. We are still only beginning the 
subject, however. It is well known that the majority of the 
cases of diphtheria which are not favorably influenced by the 
use of diphtheria antitoxin, are the so-called septic cases, in 
which the organisms of suppuration really dominate the pro- 
cess. Such cases are, of course, uninfluenced by diphtheria 
antitoxin, and it may be that in the near future we shall be 
injecting both antitoxic serums in such cases. The optimistic 
eye may even look forward to a day when we shall return to 
the use of " shot-gun formulae," and give our patients a serum 
warranted to protect against a dozen diseases. 

The use of streptococcus toxins in cases of inoperable 
malignant disease is still persevered in, and favorable results 
have been reported. Coley, an authority on this subject, 
states in a recent communication, that the various forms of 
malignant growths react very differently to the toxin treat- 
ment. The carcinomata seem to be unsusceptible to it, as are 
the melanotic sarcomata, while the results are most favorable 
in the cases of spindle-celled sarcomata. 

The bubonic plague has occupied the attention of many 
bacteriologists, especially those associated with quarantine or 
city sanitation. A great deal of work has been done in pro- 
ducing an antitoxic serum, and one of the two methods of 
treatment used in India consists in the use of such serum 


(Yersiu's). The other method, that of Haffkine, consists in 
the use of attenuated cultures of the plague bacillus, thus 
producing an active immunity. Yersiu's serum is prepared 
similarly to diphtheria antitoxin, and seems more adapted to 
the actual treatment of the disease, while Haffkine's procedure 
seems more valuable from a prophylactic point of view. No 
reliable results have as yet been reported. 

It is claimed that the causative micro-organisms of a major- 
ity of the cases of baldness has been discovered. It seems 
hardly probable that we shall be able to obtain an anti- 
alopecic serum, though its appearance would be hailed with 

A great deal of work has been recently done upon Welch's 
bacillus aerogenes capsulatus. This bacillus has certain 
marked peculiarities, among them, the production of inflam- 
mable gas in the tissues of the body. Several cases of sudden 
death, associated with the presence of this bacillus, have 
recently been reported. 

In concluding, note should be made of the extension of 
the use of formalin gas as a disinfectant and germicide. The 
vapor is practically harmless to books, leather, cloth, etc., can 
be cheaply produced by means of various generators recently 
devised, and seems destined to take the place of the old 
unreliable sulphur candle. 

No mention has been made of the claim of Sanavelli, an 
Italian bacteriologist, to have discovered the causative organ- 
ism of yellow fever. Such claims, unsupported by proofs, are 
rarely worth considering, and indeed, contribute not a little to 
the dubious position which the science of bacteriology holds 
in the minds of a few of the elder practitioners. 




Progress of Ophthalmology and Otology. 


The subject is vast. An exhaustive exposition can scarcely 
be placed in a paper of this kind. And while aware of its 
many shortcomings in failure to record all the new remedies 
and procedures, yet I hope it may contain food for thought. 
If one would investigate in a medical library, he would find a 
large number of monthlies and quarterlies devoted almost ex- 
clusively to these two subjects ; and the profusion of papers 
constantly appearing, many of them having been read before 
societies, he would come to the conclusion that progress must 
certainly have been made, ind so there has been. Besides, 
the latest discoveries and results of study are today most 
freely exploited and very accessible. 

A new system of diseases of the eye, by American, British, 
Dutch, French, German and Spanish authors, edited by Drs. 
Norris and Oliver, of Philadelphia, in two volumes, is worthy 
of mention. Several authors have spoken of the excellent 
results of 1-2,000 Formalin solution in muco-purulent conjunc- 
tivitis, Burnet thinks its great penetrating power is its chief 
advantage over other anti-microbic remedies. 

Carl Mellinger, Basle ("Abstract in Archiv. Oph.," April, 
97), concludes as to sub-con junctival injections, that their 
beneficial action is due to their stimulating effect upon the 
lymph circulation of the eye. Secondly, that 1-2,000 bichlor- 
ide injections set up an adhesive inflammation, causing an 
obliteration of the sub-con junctival space. Thirdly, that sub- 


conjunctival injections of salt solutions have the same favor- 
able therapeutic effect without their ill results. There are 
many favorable reports. Dr. Guttmann, Berlin, decries them 
after having an experience with only fifty injections. 

Dr. Edward Jackson ("Arch. Oph.," Aplril, '97) proposes an 
arrangement which gives an enlarged view of the field of 
operation. This mechanism would prove of service to all 
surgeons, especially when an operator is a presbyope. 

Schanz, on the Etiology of Pseudo membranous Conjuncti- 
vitis ("Arch. f. Augenheilk, xxxiii."), claims to have found 
bacilli which were not to be distinguished from Klebs-Loeffler 
diphtheria bacilli, the relations between the virulent and 
non-virulent not yet being clear. 

Dr. Bryant, Omaha, Neb. ("Arch. Oph.," Jan., '97), in mild 
burns immediately loosens them and passes ligatures to con- 
vert them into a small wound. 

The author of this paper presented a case to the New York 
Academy of Medicine, March 16, 1896, where there had been 
a deep burn of the orbit by molten metal, in which the lids 
were drawn together by contraction of the cicatrix, until 
even the smallest glass eye could not be worn. The cicatrix 
and good tissues beneath were pierced and opened up to allow 
of the insertion of a button in the pocket thus made. The 
button was covered with a fresh Thiersch graft. After several 
days, the button being removed, the graft was found every- 
where attached, and a good, new socket was formed which 
readily admitted a proper size of glass eye. The author has 
to report a second similar case with like success, and also a 
case of symblepharon, where the lower lid was attached to the 
ball opposite the pupil. In this case the attachment to the 
ball was released by passing a knife close to the cornea, down 
to and below what would have been the fornix of the conjunc- 
tiva. In this space was then inserted a piece of green protect- 
ive, such as the surgeon uses, covered with a fresh piece of 
Thiersch grafting. Three stitches were taken through graft 
and protective at the bottom of the fresh wound, holding them 

PAPER. 247 

bent upon themselves in apposition with the fresh cut surfaces. 
These three stitches were brought out through the skin and 
fastened. Stitches on each side of the occular graft at corneal 
junction held it in place. This graft readily grew and became 
attached to the eyeball and did not perceptibly contract, but 
the palpebral graft, on account of the looseness of the tissues, 
contracted and a second operation will relieve the tension, 
thus commencing anew. But even without this, the ball is 
freed from its former restricted motion, and may move in any 
direction without giving pain. 

Cohn found the number of persons blind from blenorrhoea 
in institutions for the blind in Germany, Austria and Switzer- 
land to be twenty per cent., and thirteen per cent, in Holland. 
Of 710 children with blenorrhoea, 506 were discharged cured, 
and 141 suffered permanent damage to sight. Gonococci 
were found 293 times among 498 cases. Cohn recommends 
Crede's procedure. 

Hosch (**Jahresber. d. allg. Poliklinik des Cantons Basel- 
Land," '96) reports an outbreak of a typical blenorrhoea 
neonat. in spite of the use of Crede's method. He believes it 
suffices to recommend to mothers and midwives, extreme 
cleanliness, and the washing out of the infant's eyes with an 
indifferent fluid, such as boric acid solution. 

Knies (" Samml. swanglosu Abhandl. aus dem Gebiete der 
Augenheilk I.," Part 5) states ophthalmia neon, is not always 
caused by gonococci, and he recommends a continuous hot' 
bath of 40 ^^ C, since a continuous body temperature of 40° 
C. causes the gonococci to disappear. 

Coe treats pterygium by touching the apex with a platinum 
probe, heated to redness. The author has employed this 
treatment in several cases with absolute success. 

A. L Ranney (**Anals of Oph. and Otol.," April, '96) 
relates a case of epilepsy in a woman which had been unsuc- 
cessfully treated by bromides and animal extracts, but who 
recovered after the latent esophoria and hypophoria had been 


corrected by numerous tenotomies. There had been no 
return of seizures one year after they were stopped. 

Marlow (" Med. News," July 4, '96) reports a case of epil- 
epsy and migraine as dependent upon eye-strain, and cured 
by the correction of the error of refraction. 

Dr. G.' O. Ring showed, as have others, that the presence 
and approximate location of a piece of metal in the vitreous 
may be discovered by means of the Roentgen rays. (" Oph. 
Record," March, '97.) 

Articles, especially one by Knapp ("Arch. Oph.," Jan. -97)^ 
have appeared; and discussions on cause and treatment of 
prolapse of the iris have taken place during the past year, 
notably at the Pan-American Medical Congress, and the New 
York Academy of Medicine, and the general concensus of 
opinion is that prolapse of iris calls for immediate excision, 
if detected at once on its occurrence. If there be inflamma> 
tion present, or it be not detected for several days after its 
occurrence, Knapp, De Schweinetz and others agree that it 
may then be treated tentatively. 


A recent writer in an admirable paper on tinnitus aurium 
made assertions which, perhaps, might be modified. He stated 
that studies both macro and microscopic in otology have 
thrown but little light on this subject, hidden as it is, deep at the 
base of the cranium. He states two-thirds of all ear cases have 
a common symptom, tinnitus. He cites a case of acute glau- 
coma of the tympanum, if you will allow the term, causing, by 
pressure on the stapes and oval window, an acute tinnitus. 
When the pressure and pain had been relieved the tinnitus 
remained as a sequellum, and he asks why ? I would respect- 
fully ask for more objective and subjective symptoms. He 
states the M. T. had healed up. Well, suppose he had been 
able to see the F. O., which in some ears may be readily seen; 
but which, unfortunately, in just the cases the examiner desires 
to see it, is often placed too high, and the edge of the ext» 

PAPER. 249 

aud. canal hinders it coming into view. But suppose he could 
have seen it. According to the latest writers, he would have 
seen the stapes firmly driven into the foramen ovale and fixed 
there ; or he would have found an exudation about the incus 
and stapes, or possibly between the malleus and incus ; or, 
again, a deposit upon and thickening of the membrane at the 
round window, or possibly a catarrhal condition of the eusta- 
chian tube. Any one, or several, or all of these conditions 
may have prevailed in this case. The doctor did not give any 
of the results as to hearing tests. The employment of these 
tests — the voice, whisper, low and high tuning forks, the 
Weber, Rinn^, Schwabach tests, and the examination as to 
whether the bones moved. These tests help by comparison 
and exclusion to show where the seat of the disease is. He 
states : ** Otology does not give as yet an acceptable explana- 
tion for every case of T. A. And in this respect we lean upon 
a crutch, reflex stimulation of the acoustic nerve. Thus do we 
explain the tinnitus which accompanies different affections of 
the external canal, which in no manner affect the middle or 
internal ear. A permanent tinnitus continuing.'' 

In answer, it is to be said some cases of T. A. are difficult 
of explanation. It may be asked, is there any symptom of 
any disease of the human body which is always explanable ? 
As to permanent T. A., due to eczema of the auditory canal 
alone, with healthy middle and internal ear, if any observer 
knows of such a case it should be reported. Perhaps closer 
investigation would show some diseased condition deeper than 
the eczema of the canal. '• Again, he says* ** It has been stated 
a large number of experiments, enthusiastically received, have 
from time to time been tried with the object of curing T. A., 
but have proved disappointing. Their advocates and the 
mode of treatment have made hardly any progress in the last 
fifteen years." He ** endeavored to depict a chapter of 
Otology in which the science still gropes in darkness and 
grasps without method one remedy after another." The 
position held by this observer having many supporters, and I 


being convinced by the limited number of cases in my own 
dispensary and private practice, that we are better and more 
intelligently able today than ever before to treat these poor 
unfortunates, have gathered together hastily for your consider- 
ation a number of points bearing upon the progress of Otology. 

A. B. Randall (" Trans. Am. Otol. Soc," Vol. vi., iii., '96) 
says : ** When one studies the singular variations of the bulb 
of the jugular vein, often intruding upon the cavity of the 
tympanum, and sometimes dilating up into contact with the 
acoustic nerve in the internal auditory meatus, the marvel 
must be that we can ever be oblivious of its bruit in health." 

In the first place, T. A. is only a symptom. It is not a 
disease p^r se. With regard to its intra-cranial causes, lye 
dismiss them by calling attention to the fact that a symptom 
of cerebral disease, as where the aura of an epileptic attack 
is T. A., need not look for cure by treatment of the middle 
or internal ear, necessarily ; nor again, in such a case as that 
cited by T. J. Harris (Manh. E. and E. Reports," Jan., '97), 
where a patient suffering with a tumor of the tempero-parietal 
region, probably a sarcoma, was relieved of his T. A. and 
vertigo by blisters, strichnine and iodide. Again, in internal 
ear disease, Harris shows that only twelve per cent, of 196 
cases including T. A. as a symptom were cured or relieved, 
and the concensus of opinion of a large number of observers 
in regard to chronic internal ear diseases is, that treatment is 
well-nigh hopeless. In passing, it may be noted the internal 
medication for internal ear troubles seems to be confined to 
pilocarpin and iodide, with hydrobromic acid. 

Now, as to the sweeping allegation that no advance has been 
made in Otology. There is scarcely a large city where, during 
the past two years, cases have not been reported of cures of 
cranial abscesses and intra and extra dural tumors. These 
cases were formerly fatal. The trephine, gouge, chisel and 
knife invade territories hitherto impregnable ante-mortem. 
The skull is first entered at the mastoid. And if the lateral 
sinus be injured, it is, today, simply placed under pressure. 

PAPER. 251 

tamponed or stitched. If it contains clot, it is cleaned out 
and packed with sterilized gauze. If a tumor or abscess is 
suspected in the region of the ear, the trephine is made to 
enter the- skull above, or beneath the lateral sinus, and the 
abscess or growth removed, and lives are being saved that 
hitherto were allowed to die because surgical interference was 
supposed to mean death. But an operator today who attacks 
the mastoid operation is prepared to go forward into the attic, 
inwards into the sinus, backwards even to the cerebellum, or 
perhaps making a second trephining above the sinus if neces- 
sary to reach the cause. This great advance is due to the 
Otologist. A partial list of such cases, with their references, 
may be mentioned : 

Extensive thrombosis of several sinuses of the brain and of 
the jugular vein, recovered ; by R. Hoffmann, Dresden ("Arch. 
Otol.," April, '97). 

Gorham Bacon (" Trans. Am. Otol. Soc," Vol. vi., iii., '96) 
reports recovery of a case of brain abscess in a man 32 years 
old, by operation. 

Robert C. Myles (ibid.) reports a case of a girl, 7 years old, 
with brain abscess ; cured by operation. 

T. D. Acland and C. A. Ballance (**St. Thomas' Hosp. 
Reports," '94) report a cure of a case of brain abscess in a 
^oy, 15 years old, by operation, and in addition give an ex- 
haustive account of the subject. 

Mr. Walker ("Brit. Med. Journ.," Nov. 21, '96) reported 
recovery of a 14 year old boy, after evacuation of an abscess 
of the left cerebellar lobe. 

Walter Ridley (" Lancet," Nov. 28, '96) reported recovery 
of a young man whose internal jugular vein had been liga- 
tured. A sub-dural abscess and blocked sinus were cleared 
out through the mastoid. 

W. R. H. Stewart (" Brit. Med. Joum.," Nov. 7, ^96) re- 
ported a recovery from pyaemia ; clot of lateral sinus removed. 

John L. Adams (" Trans. Am. Otol. Soc," Vol. vi.; iii., '96) 


reported a recovery by means of an operation, of a thrombosis 
of lateral sinus. 

E. B. Dench (ibid.): Similar case, with cure after operation. 

E. B. Dench (ibid.): Otitic meningitis ; operation ; cure. 

H. Knapp (ibid.): Opening of mastoid and cranial cavities,, 
followed by cure 

Prof. Zaufal, Prague (" Prague Med. Wochenschr.," No. 49^ 
'96): Ligates jugular vein for perisinous abscess, and recovery^ 

E. Remini ("Bolletino delle raallatti dell orecchio," p. 161,. 
'96) reports thrombosis of lateral sinus ; operation ; cure. 

Dr. H. Enlenstein (**Arch. OtoL," April, '97) reports his 
third case saved after excising the jugular vein for throrabo- 
phlebitic condition. 

Prof. Urban tschitsch reports cases of sub dural abscess, 
with cure. 

J. M. Cotterell (** Scottish Med. and Surg. Journ.," '97): 
Cerebral abscess ; recovery. 

It is worthy of note that Dr. Tiffany, of Baltimore, calls 
attention to the preference of chloroform as against ether, in 
all operations about the head. The frontal sinus, the antrum 
of highmore, the superior maxillary fossa, and the naso- 
pharynx, are now all more intimately known to be the seat of 
disease which heretofore has failed of recognition, a cure of 
the disease in any one of these parts often relieving symptoms 
which have been referred to other parts — the eye, the ear or 
the brain, the circulatory or the nervous system. 

Prof. Bezold, of Munich, holds that '* in simple ear diseases 
and so-called sclerosis, where they depend upon disturbances 
of the sound transmitting apparatus, there is an interference 
with the mobility of the base of the stapes, and we may 
assume that the transmission of the lower sounds is normally 
performed by the chain of ossicles which is not at all neces- 
sary for the highest sounds. In middle ear affections, air 
conduction for deep sounds is reduced, compared to bone 
conduction. In sclerosis, the high sounds suffer also. De> 

PAPER. 253 

fects at the upper end of the scale are not of very great aid in 
diagnosis, but when joined to shortening of Schwabach's test, 
a nervous affection can be supposed." 

Dr. Leutert Halle claims that if pneumococci are found in 
the middle ear or in the mastoid process at operation, compli- 
cations may be expected, /. ^., in the latter, an epidural 
abscess may be looked for. 

Dr. Oppenheim, Berlin, says : *' Otitic abscesses may remain 
occult even if large, and their diagnosis is difficult as against 
meningitis, sinus thrombosis and extra dural abscess. Other 
cerebral affections, with or without ear troubles, may compli- 
cate the symptoms, as otitis media, serous meningitis, brain 
tumor, arterio* sclerosis, hysteria and others. There may be 
few symptoms. It is well to be on the lookout for spinal symp- 
toms, like stififness of the back, rigid extremities, radiating pain, 
disturbance of tendon reflex, bladder and rectum symptoms. 
Fever is not a diagnostic point unless continued. The most 
important point is slowing of the pulse. Dr. Ostmann Mar- 
burg called attention to changes of the eye consequent on ear 
-disease. In severe otitic suppuration, changes at the optic 
papillae are noted and the importance of an ophthalmoscopic 
examination acknowledged. In thrombosis of the cavernous 
sinus, the swelling of the eyelids is the most characteristic of 
the occular symptoms." 

Prof. Schwartz, at Frankfort, Sept. 22, '96, presented 2,000 
•carious mallei which he had removed and he speaks guardedly 
of the Stacke operation. 

Dr. Cohen-Kysper, Hamburg ("Arch. Otol.," April, '97), 
cured 100 out of 150 double deafness cases, using an injection 
•of hog pepsin or papayotin about the stapedial articulation. 

Dr. Gelle ("Arch. Intern, d Lar. Otol. et Rhin.," Jan. and 

Feb., '97) holds that the stapes, though fixed, by means of its 

thin foot plates, still transmits the molecular vibrations to the 

labyrinthian fluid. Only the amplitude of the vibrations is 


In passing, attention is called to the value of soap in the 


use of the laryngoscope and Siegle otoscope. If it be 
smeared over the mirror and wiped off, the breath fails to 
deposit its moisture and the mirror remains bright. 

Phillips advises that at the very onset of an attack of any- 
one of the exanthema, the nose and naso-pharynx should be 
frequently and thoroughly cleansed. A spray of warm saline 
solution, alternating with medicated sprays, should be em- 
ployed. In the University of Christiana, cases of Ot. M. fol- 
lowed nasal douches, even when properly performed, and they 
now use a catheter for nasal douches, perforated along its 

I. E. Sheppard ("Trans. Am. Otol. Soc," Vol. vi., iii., '95) 
records 1 14 cases of mastoid involvement of acute O. M. Supp., 
with most valuable deductions and with the conclusion that 
when in doubt about mastoiditis, operation should be done. 

Friedenberg (" Med. News," Oct. 24, '96) reports four cases 
in which it was necessary to open the mastoid cells, and says 
that these cases are merely types in which disease of the 
mastoid, acute or chronic, produces great destruction within 
the bones, the symptoms not arising until the pathological 
process approaches or reaches the meninges or the semicircular 
canals or the periosteum. And he arrives at the conclusion 
now generally agreed to, that in any case in which a purulent 
discharge continues from the middle ear, or extensive carious 
destruction of the contents and walls of the tympanic cavity 
exists or has existed at any time, latent mastoid disease should 
be considered as a possibility and guarded against. 

Grunert says, as to improvement in hearing, in anchylosis of 
the stapes-vestibular joint, nothing is gained by operative 
removal of the stapes in affections of the labyrinth or of the 
round window, and the effect on tinitus is doubtful. 

C. J. Kipp (" Trans. Am. Otol. Soc," Vol. vi., iii., '96) re- 
ports a recovery of a case of otitis media, pur. and mastoiditis, 
complicated with erysipelas. 

Toeplitz (" Post-Graduate," Nov. i, '96) offers a radical 
cure for chronic O. M. Supp. which is confined to the attic, in 

PAPER. 255 

which the malleus and incus only are carious, without impli- 
cation of the bony walls. He says a series of his opera- 
tions confirm the view that removal of the ossicles alone will 
effect a radical cure. He also believes that when the sur- 
rounding bones are carious, even into the petrous bone, Stackers 
operation of removal of all carious tissue promises a complete 

Broca {" Ann. des mal de Toreille," &c., Nov., '96), on the 
intra-cranial complications of O. M., in acute cases opens the 
mastoid antrum, and in chronic cases goes further into the 
tympanic cavity. Carious bone is suspicious of extra dural 
abscess. In sinus thrombosis he prefers ligation of the jugular. 
The starting point for operations is the antrum, and he says 
this ought to be the rule in cerebral and cerebellar abscesses. 

Albert H. Buck (" Med. Record." May 29, '97) calls atten- 
tion to goutiness in its relations to diseases of the ear, show- 
ing the necessity for constitutional as well as local treatment. 

Muralt (" Journ. L. R. and Otol.," London, May, '97), by 
means of the Urbantschitsch method, has developed the faculty 
of hearing in three deaf and dumb children. 

Macewen, in the " Occidental Medical Times," Nov., '96, 
gives five lectures on the surgery of the brain, a most valuable 
contribution to the literature on obscure cases of tumor or 
abscess of the brain which should not be confined to the 
specialist, but are of importance to the general practitioner. 

Lautenbach (" Trans. Med. Soc. Pa ," '96) advises thorough 
cleansing for O. M. pur., combined with suction massage. He 
advises massage and pneumo-massage for deafness, with or 
without perforation, claiming sclerosis of the parts and a 
driving in of the stapes into the F. O. In the Phil. Co. Med. 
Soc, Sept. 26, '94, he claims defective hearing is due to the 
rigidity of the conducting apparatus and contraction of the 
ossicular arch, and says : " For ossicular attachments, over- 
weightings and shortening of ossicular arches, suction massage 
stimulates, makes healthier mucous membrane, hastens absorp- 
tion of morbid deposits, and gives normal activity to muscles 


and ligaments, and at the same time increases the. amplitude of 
joint movements. It is really the reverse of shock and factory 
sounds of jamming-in of the round window." 

Now, to sum up. I have, with perhaps some irregularity, 
given proof, with references, of the progress in the study of 
eye and ear diseases, and can only say that, as Lautenbach 
teaches, if the middle ear be thoroughly, persistently, patiently 
cleansed and studied in any individual case, the cause for 
symptoms may be discovered by the employment of means at 
hand today. Swellings of the auditory canal, polypi, granula- 
tionsy exudations and anchyloses being relieved, a cure will 
follow in cases where formerly discharge and all the other 
symptoms failed of cure. It is worthy of note to mention the 
good success of antinosine solutions in catarrhal troubles of 
the middle ear and eustachian tube, and of nosophen as a 
substitute for iodoform, and also, that local treatment of 
catarrhal and other afifections of the eye and ear is not all that 
is necessary. It should generally be supplemented by consti- 
.tutional treatment. 

One thing more. Without going into minute details which 
would be out of place in this paper, brilliant results have been 
obtained in my hands in the case of patients suffering with 
deafness or T. A., or both. Perhaps it would be well to 
insist upon two things in any given case. First, if there be 
any discharge, the canal, or if the drum be wholly or partially 
absent, the canal and the tympanum must be made and kept 
clean. This necessitates, of course, the removal of all causes 
of discharge. Secondly, the rigidity of the F. O. and F. R. 
must be dispersed, if possible. 

For the first, the author has found best success by syringing 
thoroughly with carbolic solution, then wiping out with cotton 
tipped probes loaded with hydrogen peroxide, and drying and 
following this with cotton tipped probes dipped in a five per 
cent, solution of antinosine ; meanwhile, with the latter, using 
gentle, careful massage about the F. O. and F. R. The cavity 
is then dried out and ready for the second indication — the 

PAPER. 257 

massage with a rubber tipped probe against the bones wher- 
ever the procedure will be allowed, care being taken not to 
produce an imflammation which might go beyond control, 
the idea being kept in mind to impart and start up vibrations 
>n a labyrinthian fluid which has for a long time, perhaps, 
been quiescent. Then the Delstanche massage apparatus is 
brought into play and the patient given instruction to use it at 
home systematically, shortening the intervals as improvement 
appears. This instrument properly used^ is of great value, 
whether the membranum tympani be present or not. Its 
excursion must be quick. It must be compressed suddenly 
and the spring should be strong enough to produce a shock in 
its return. Old rusty joints will not budge with passive 
motion. Of course, pain is a short stop, and the excursion of 
the pump must be modified to meet individual cases. In the 
meanwhile, the nose and naso-pharynx and constitutional 
hygiene are looked after. 




Report on Diseases of the Nose and Throat. 

In preparing this brief report of the year's progress in the 
treatment of diseases of the nose and throat, I shall omit 
mention of the one which transcends all others in interest and 
importance, viz., the antitoxin treatment of diphtheria, being 
informed that several papers on that subject will be presented 
for your hearing and discussion. 

in the voluminous literature of the year scattered through 
general and special journals, it is not difficult to select two or 
three subjects particularly interesting to the general practi- 
tioner, in which something like substantial progress has been 
made or original work done. Since the discovery of the 
laryngoscope, no addition to the armamentarium of the laryngol- 
ogist has been made which equals in importance Kirstein's 
invention of autoscopy, or the inspection without a mirror of 
the interior of the larynx and trachea. Kirstein himself defines 
"autoscopy of the air passages as the direct linear inspection 
through the mouth of the lower pharynx, the larynx, the 
trachea and the entrance into the primary bronchi." The 
practice of this remarkable art requires no extensive apparatus. 
For illumination, the ordinary McKensie condenser, with fore- 
head mirror, will meet the case fairly well, but is far inferior 
to the inventor's forehead lamp for reflected light, in which 
the rays of the electric light, after they have been collected by 
a convex lens, are deflected at a right angle immediately on 

PAPER. 259 

issuing from the lens, by a small plain mirror placed at an 
angle of 45° to it. The autoscope itself is, in brief, but a 
narrow, deeply grooved spatula about fourteen centimetres in 
length. To keep the tongue out of the straight line of vision, 
the spatula is straight except at the end, where it is slightly 
curved downward so as to lift the epiglottis by its pressure 
upon the base of the tongue. Its tip is rounded to prevent 
injury to the mucous membrane, and slightly notched to 
receive the median epiglottidean ligament. Experience will 
probably demonstrate the wisdom of having several spatulge 
of different lengths and widths. A nickel plated hood may 
be attached to each spatula to prevent the upper lip, or 
beard in men, from obstructing the line of vision. But this 
device, I think, is rarely needed, and its omission would greatly 
facilitate the use of laryngeal instruments. 

The technique of autoscopy is extremely simple. The 
patient sits, the body inclining slightly forward with the head 
tilted slightly backward. The physician standing before the 
patient, places the deeply grooved spatula as far back as pos- 
sible upon the tongue, and makes very firm pressure downward 
and fonvard upon the root of the tongue, by which procedure 
the epiglottis is raised, a deep chanel made along the base of 
the tongue and a straight line formed from the laryngo-tracheal 
axis to the observer's eye. This line being well illuminated 
with the forehead lamp, a good view of the air passages may 
be had. As the inventor says : " An incomparably complete 
view of the posterior wall of the larynx, the entire inner surface 
of the trachea, as well as the entrance of the bronchi." 
It is too early to attempt to define, even approximately, the 
range and limitation of autoscopy, but in endo-laryngeal and 
endo-tracheal surgery it must, I think, to a considerable extent 
supersede the laryngoscope ; for with the autoscope the 
foreign body or growth is itself seen, and not \is picture in a 
mirror, and we may operate in a straight line and not around 
an angle. This method is said to be of especial value in 
examining the larynges of children. Accounts highly extolling 


the autoscope for the very easy and expeditious removal from 
the upper air passages of such growths as polypi and papil- 
lomata and such foreign bodies as a breast-pin, a chicken bone, 
etc., are now frequently reported in the special journals. 

X'Ray. — The aid of the X-Ray has been employed in the 
diagnosis of affections in this branch of medicine, but thus far 
no achievement of first-class importance can be recorded, 
though two instances have been reported during the year, of 
the localization and photography of coins in the gullet, and 
one of a bullet in the larynx Thompson, Mclntire and others 
have devised focus tubes and fluorescent screens for introduc- 
tion into the mouth, by which, when perfected, it is expected 
we may detect foreign bodies in the throat and nose and 
important deviations of the facial bones. With the aid of 
these new devices I think the X-Ray just now promises more 
than has yet been realized from it for diagnostic assistance in 
the upper air passages. In this connection especial mention 
should be made of Dr. Mclntire's fluorescent screen to be 
introduced into the buccal cavity for examining the interior of 
the larynx, and Dr. French's admirable recent work in laryn- 
geal photography by means of a 2,000 candle-power arc lamp. 

Goitre and Thyroid Treatment. — From the most careful study 
I have been able to give to the year's literature on this inter- 
esting point, the following conclusions are warranted : That 
whatever reliable preparation of the thyroid gland be used, 
recovery from goitre may pretty certainly be expected in child- 
hood and youth ; that after twenty or thirty-five, the treatment 
rarely if ever produces a perfect recovery ; that a majority of 
adult cases are improved by the treatment, frequently to a 
very marked degree, but there is always and inevitably a tendency 
to relapse upon the withdrawal of the remedy ; and finally, 
that preparations of this gland are not free from danger if 
used for a considerable . time in large doses. Angerer reports 
one death during the year from heart paralysis, due, in his 
opinion, to thyroid extract. Morris, of London, and others 
report cases of recurring angina pectoris of very intense 

PAPER. 261 

character, occurring while the patients were under treatment 
by tabloids of thyroid, "and which ceased upon the withdrawal 
of the remedy. 

Adenoids, — The year has been marked with rather more 
than usual literary activity upon the subject of post-nasal 
adenoids, and it is gratifying to be able to report that some- 
thing like unanimity of opinion has been reached upon these 
practically important points, viz., the indications for, and 'the 
methods of operations, on these growths. These conclusions, 
summarized in a recent discussion by Greville MacDonald, 
Lenox Brown and others, are as follows : i. — The necessity 
for operation depends not only upon the quantity of the 
growths, but upon the mischief they are doing. 2. — That 
wherever there is middle ear mischief of any kind, every 
vestige of adenoids should be removed. 3. — Wherever there 
is constant tendency to cold taking, especially with bronchitis 
or chronic laryngitis, we should operate. 4. — When we have 
paroxysmal sneezing, asthma, laryngismus stridulus, chorea or 
similar maladies, we should operate, but with very guarded 
prognosis. 5 — Where the symptoms are trifling and the 
patient appears to be improving, rather than the reverse, we 
may wisely postpone operation, especially if we can see the 
case from time to time. 6. — That the method of operation is 
of little importance, provided it is thorough, 7. — That the 
frequent recurrence — as it is erroneously called — of these 
growths, indicates almost invariably an incomplete previous 

Relation of Uric Acid Diathesis to Hay Fever, — During the 
year a constantly increasing volume of testimony has been 
recorded concerning the causative relation of uric acid dia- 
thesis to hay fever. Thus, Joal found among 127 cases of 
hay fever patients, a family history of the uric acid diathesis 
in 107 cases, most of whom were cured or greatly relieved by 
treatment directed to this condition, and without intra-nasal 


surgery. And Sir Dyce Duckworth is quoted in the last 
Lettsomian lecture as being of the opinion that hay fever was 


especially frequent in gouty families, and as regarding the 
changes in the mucous membrane of the nasal passages as akin 
to the eruptions which vex the skin in gouty subjects. Dr. 
Scott Bishop, in his " Diseases of the Nose and Throat," just 
published, expresses the enthusiastic opinion that with this 
new theory in his mind, the general practitioner, by means of 
appropriate therapeutics and diet, can heal a large number of 
these cases without reference to the rhinologist. It is recom- 
mended that for a month before the expected attack, small 
doses of sodium salicylate should be given, just a sufficient 
quantity to keep the acid in the body down to its normal 
amount. The stronger lithia waters have also been found 

No entirely new remedies have been proposed during the 
year which have thus far shown themselves to possess real and 
permanent value, with the exception, perhaps, of blennostasine. 
This drug — a bromide derivative of cinchonoidine — I am 
inclined to think, after a considerable observation, will be 
found a very useful addition to our remedies for conditions of 
the upper air passages characterized by tumefaction, hyper- 
secretion or hypersesthesia. In sharp colds, especially those 
having the character of grip, it is extremely useful, aborting a 
considerable number of cases with remarkable promptness In 
paroxysmal sneezing, hay fever and other hyperaesthetic con- 
ditions of the nasal mucous membranes, its sedative and blen- 
nostatic effect is equal to that of belladona, with the added 
advantage of being non-poisonous. In acute laryngeal colds 
of singers and clergymen, I have seen several cases where the 
drug had a very remarkable effect in the prompt restoration of 
the professional voice. Being very bitter, like other alkaloidal 
salts of cinchona, it is best administered in pills or capsules. 
In acute conditions, one grain every half hour untiL desired 
effect is produced, and in chronic cases five grains four or 
five times daily. I have never observed the slightest un- 
pleasant effect from the drug. 



An Account of a Patient in the New Jersey 
State Hospital who Swallowed Numer- 
ous Indigestible Articles with 
Suicidal Intent. 

I am not prompted to relate before this Society this unique 
case with the hope that it will prove instructive, either from a 
medical or surgical standpoint. It is simply interesting 
because of the rarity of such cases and the fact that the 
patient swallowed without being detected by physicians, 
attendants or fellow-patients, articles of an indigestible char- 
acter of such quantities, shapes and sizes that a mere state- 
ment of the case, without positive and conclusive evidence, 
would be calculated to excite doubt in the mind of the ordinary 
hearer as to the authenticity of the statement It is not an 
uncommon occurrence to see sensational accounts in news- 
papers, but medical men either reject them in their entirety or 
take them cum grano salts, I will briefly give you a sketch of 
the patient. 

J. W. Was admitted to the New Jersey State Hospital, 
July 8, 1895, aged ^^> He was a man of alcoholic and tobacco 
habits. He was suffering, at the time of his admission, from 
chronic melancholia, with a history that the attack was of five 
years* duration. He was a native of the United States, and 
was of a wandering disposition ; had lived in California and 
spent some years in Australia. When the plumbers were 


working in the cellar of his home, thawing out pipes, and the 
smoke came up through the floors, he claimed that they were 
doing it to injure him. His mental derangement became so 
great that it was found necessary to have him committed to an 
institution for treatment. Soon after his admission to the 
N. J. State Hospital he began to exhibit, in a marked manner, 
delusions of persecution, and saying that there were numerous 
persons who were "down on" him. He was placed under 
close observation and showed no improvement in mind ; on 
the contrary he gave evidence of progressive mental deterior- 
ation, and the development of that secondary condition known 
as dementia. 

In the summer of '96 he made several attempts at suicide. 
He tried to hang himself with a towel, but was not successful. 
He subsequently tried to cut his throat with a knife while at 
the dinner table. Close watch was put over him, and he was 
not allowed to have a knife at the table or sit at the table 
where knives and forks were used. On October 31, 1896, 
while eating his dinner in his room, waited on by an attendant, 
he availed himself of an opportunity, while the attendant was 
getting a towel for him, to break the handle off a large table- 
spoon and thrust it down his throat. The attendant, turning, 
detected him, and attempted to grasp the end of the handle 
and withdraw it, but the patient gave a sudden gulp and the 
handle went into the stomach as naturally as the small boy 
would swallow a cherry. Notice was then given to the physi- 
cian, and his case was investigated. Realizing he had been 
detected in the act of swallowing a spoon handle, he admitted 
that he had swallowed numerous articles, consisting of.buttons, 
buckles, pieces of tin, pieces of glass, stones, mattress wire« 
etc., etc. An examination was made of him by palpation, and 
developed the fact that his stomach contained numerous 
articles very hard to the touch, which was considered a suffi- 
cient confirmation of the ttuthfulness of his statements. His 
case was reported to the medical committee of the board of 
managers, and they considered carefully the probabilities of 

PAPER. 265 

his recovery, the character of his mental derangement, and 
after weighing all the facts in the case attentively, concluded 
that it would be better to await developments rather than open 
up the stomach and remove the articles. Acting under their 
suggestion, I had him watched closely and all the discharges 
from the bowels inspected. This resulted in our obtaining 
from this channel sixteen stones. 

Whether before the time this patient was detected in 
swallowing the spoon handle, he had had any symptoms char- 
acteristic of acute gastritis, cannot be definitely determined, but 
he did not complain of any unusual feelings and exhibited no 
such symptoms which came under the observation of his attend- 
ant. After careful examination had been made of him and his 
attention attracted to his stomach by the frequent examinations 
and the anxiety of the medical staff about him, he complained 
of a gnawing sensation in the stomach. His temperature was 
taken daily and for four weeks ranged from normal to 100 F. It 
was noticed that he was losing flesh, and nutritious liquid diet 
was given to him freely. At times he was stubbornly constipated 
and it was necessary to give him enemata of soap and water. 
Following these enemata would be an action from the bowels 
containing particles of coal, and from time to time a stone. 
On one or two occasions he vomited up his food. He failed 
in general health and lost flesh steadily, and died February 15, 
1897, three and one-half months after he was detected swallow- 
ing the spoon handle. 

How long he had had the greater number of these articles 
in his stomach I am unable to determine. Some of them may 
have been in there a year or two. How many stones such as 
we obtained after we put close watch upon all discharges from 
the bowels, had been passed unobserved, we, of course, had no 
way of ascertaining. According to the statement of the 
patient, he had swallowed a large number. The explanation 
for swallowing these things, given by him, was that the hospital 
authorities had prevented him from having a knife or any of 
the means usually used for taking life, and that he had swal- 


lowed these articles with suicidal intent from time to time 
when opportunity was given him. 

To persons not well acquainted with the care of the insane, 
there may arise a question as to why he was allowed to 
swallow stones without being detected In answer to this I 
would state, that when patients go out walking they are not 
prevented from picking up stones or pebbles, or picking flowers 
and amusing themselves in a general way. It is extremely rare 
that they will swallow articles of this kind, and this patient, 
not being suspected, picked up these things and put them into 
his pocket until an opportunity was afforded and then swal- 
lowed them. The suspender buckles he took off his own 
suspenders when he was not being watched closely. The 
piece of spiral mattress wire he quietly twisted from his mat- 
tress spring during the night. This, of all the articles which 
we found in his stomach, must have been the most difficult to 
swallow. I was present at the autopsy and watched closely 
the removal of the articles, which are as follows : Three 
complete teaspoons, 6 spoon handles, 3 handles of tin cups, 

1 pantaloon buckle, 3 pieces of suspender buckle, 3 buttons, 

2 pieces of tin, the brass back of a comb broken in two pieces, 
26 pieces of glass, 28 stones, i piece of slate, i large piece of 
spiral mattress wire, 26 small pieces of wire. Six stones were 
found in the intestines, and 16 of the collection were passed 
per rectum before death. 

The following interesting points are demonstrated by this 
case : 

First. That the function of deglutition may be so changed 
and so held under the control of the will, that articles may be 
swallowed of shapes, composition and sizes out of all propor- 
tion to the ordinary conception of a human being's swallowing 

Second. That the stomach will take care of a large amount 
of indigestible substances for a long time without exhibiting 
serious acute symptoms. 

Third. That sufficient quantities of indigestible material 

PAPER. 267 

may be swallowed by a person without setting up an acute 
condition sufficient to cause death, but which will so interfere 
-with the digestive processes as to cause death by inanition. 

Fourth. That an insane person with a fixed determination 
to commit suicide, can do so in the face of constant watching 
and separation from the ordinary means by which and through 
which suicide is committed. 



Report on Surgery. 

The By-Laws direct that " the annual report of the com- 
mittee shall also present a brief summary of the progress- 
made by the medical profession-at-large during the year in the 
following departments/' and " each member of the Standing 
Committee shall prepare a paper on the progress made in one 
of these departments." The summary must be " brief." To- 
me has been assigned the preparation of the report on surgery. 
The field for gleaning is enormous. I am puzzled how 
best to obey the behest of the Society, but decide ta 
present some brief abstracts of the prevailing thought of the 
profession as to the most judicious methods of treating those 
cases of surgery that demand the immediate attention of the 
medical man. 

In the "Medical Record," January i6, 1897, J. B. Murphy^ 
M.D., Chicago, reports two cases of end-to-end suture after 
resection of blood vessels injured in continuity. In the first,, 
the femoral and internal saphenous veins were perforated by a 
bullet. They were exposed and sutured with a continuous 
silk suture. Five weeks afterward, during which time free 
suppuration had taken place in the wound, active hemorrhage 
was found to proceed from a slough which involved the inner 
side of the femoral artery to the extent of an inch. The 
artery was ligated above and below the damaged area, which 
was resected. Recovery followed without cedema or other 
circulatory disturbance of the limb. In the second case, the 

PAPER 269 

common femoral was perforated by a pistol ball through its 
-centre, about an inch and a half below Poupart's ligament. 
The greater part of the wall of the artery was torn away. 
The femoral vein was also perforated just above the junction 
of the profunda. The artery was gently secured by clamps, 
and the wounds in the vein were sutured. By this the calibre 
of the vein was greatly diminished, but it soon dilated to 
about one-third its normal diameter. Two inches of the 
artery were then exposed, and half an inch of its continuity 
was resected. The proximal end was deprived of its adven- 
titia for one-third inch and then invaginated into the distal 
«nd to that extent by four double-needled- threads, whiph pene- 
trated all the walls of the artery. A row of sutures was 
placed around the overlapping distal end, the sutures penetrat- 
ing only the media of the proximal portion. The adventitia 
were then drawn over the line of union and sutured and the 
clamps were removed. Not a drop cf blood escaped at the 
line of suture, and pulsation was immediately restored to 
parts below. No oedema of the leg followed and the circula- 
tion of the limb was good continuously from the time of the 
operation. The wound suppurated, but healed satisfactorily. 
Dr. Murphy concludes that this procedure is applicable only 
to vessels of large size, and advises great care and delicacy in 
handling the vessels to avoid thrombosis and injury to the 
intima and consequent inflammatory complications. 

In 1895, Gluck reported to the Berlin Medical Society, the 
suturing of the arterial wall in an arterio-venous aneurism. 

Heidenbain ("Centi ftir Chirurgie," 1895, No. 49) reports a 
case in which, during the removal of a breast, the axillary 
artery was wounded. The edges of the wound were caught 
with haemostatic forceps and a continuous suture of catgut 
introduced with fine needles The wound was packed and 
not closed for 48 hours. The case recovered completely and 
there was no evidence of a traumatic aneurism when the 
patient was examined six months later. 

A Ntiv Mode of Ligaturing, — In ^he " American Gyneco- 


logical and Obstetrical Journal" for February, 1897, Hermann 
Grad, M.D., House Surgeon of the Woman's Hospital, New 
York City, describes a method which he has devised for so tying 
a ligature that it may be removed without cutting. He places 
under each tie of the knot a loop of silk to be used as a 
tractor. The first loop involved in the ligature is designated 
by one simple knot ; in the next tie a loop with two knots is 
included ; in the next, a loop with three knots, and so on. 
When it is desired to withdraw the ligature, the loop with 
the largest number of knots is seized and gently drawn upon 
with a Sice-sawing motion, until the last tie made gives way. 
The loop is then withdrawn and the process repeated 
with the loop remaining and having the largest number of 
simple knots, and so on until the loop with the single knot is 
reached. When this is withdrawn the ligature may be readily 
removed. The device is a very simple one and far more 
efficient than any previously known. It is especially service- 
able in the ligaturing of deep-seated stumps or pedicles after 
the removal of intra-abdominal or pelvic tumors. 

Just here it seems proper to call attention to the use of 
intravenous saline injections in the condition of extreme shock. 
Lewis A. Stimson, M.D., Surgeon to the New York Hospital, 
in the " Medical News," of December 19, 1896', contributes a 
series of cases, in which he shows its efficacy in shock with or 
without severe hemorrhages, externally or into the cavities of 
the body. Similar advantages may be gained in severe septic 
conditions. Dr. Stimson remarks that "while no direct cura- 
tive effect has been proved, the injection gives to a patient 
who apparently has but a few minutes or hours to live, a 
respite, during which his organism may recover from the shock 
received or throw off a septic assault that is pressing, or during 
which the physician may, perhaps, successfully employ rem- 
edial or helpful measures." The same effect may be accom- 
plished, though more slowly, by injecting the "normal salt 
solution " into the sub-cutaneous tissues. 

SchUich's Method of producing Local Anesthesia, — Dr. Jno. A. 

PAPER. 271 

Wyeth, of New York, in the Dec. 12th number of the " Medical 
News,** advocates very strongly the use of the Schleich solu- 
tions for inducing cocaine-anesthesia preparatory to operations. 
He says : ** To throw a solution of cocaine into the deeper 
corium or into the sub-cutaneous areolar tissue, is a waste of 
material and time, and involves a certain amount of danger, 
especially if the solution is injected into the areolar spaces/* 
It is desired here to embody a caution. After the use of a 
tourniquet, if this is suddenly loosened, a dangerous amount of 
cocaine suddenly carried to the heart, and with serious 
effect. Dr. Wyeth therefore loosens the tourniquet for a 
period of three or four seconds and then readjusts it for 
several minutes, and repeats the procedure. In this way the 
effect of the cocaine is distributed over a wide area and pro- 
duces no bad effect. 

In the ** Lancet,** April 10, 1897, is the report of a case of 
tetanus treated by biniodide of mercury bath and antitoxin, 
with recovery. The wound was a punctured wound of the 
hand from glass, for which the boy of 15 was removed to the 
* Sussex County Hospital. The first symptom of tetanus 
occurred on the twelfth day, when the wound was immediately 
incised and the hand and forearm immersed in a biniodide of 
mercury bath, i to 500. Chloral was administered in full doses. 
Tetanus- antitoxin could not be obtained until two days after 
the onset. The hand and arm having been continuously im- 
mersed, the palm and dorsum presented large blebs. Absorp- 
tion must have been considerable. The administration of the 
bath was quickly followed by a great amelioration of symptoms. 
When, after the discontinuance of the continuous immersion, 
the symptoms became more severe, the use of the bath was 
noticeably followed by relief. There was at no time any sign 
of salivation or soreness of the gums. The boy was improving 
when the antitoxin was administered, and there was no ap- 
parent reaction after either injection This case has been 
noticed for the purpose of calling attention to the apparent 
value of a solution of mercuric biniodid as a bath in tetanus. 


Corrosive sublimate has been used successfully when given 
sub-cutaneously. Celli reported a case in 1894. A review of 
a number of cases reported in the journals and seen in the 
hospital and private practice during the year, makes it quite 
difficult to estimate the value of Tissoni's antitoxin. Its use 
has been generally disappointing. In some cases it has 
certainly increased the number and severity of the paroxysms. 
In cases in which the incubation period has been short, or 
those in which, with a moderately long period of incubation, 
twelve days or so, the disease has rapidly developed, the 
paroxysms being frequent and severe, the antitoxin has had 
. no appreciable effect in mitigating or controlling the paroxysms 
or lessening the number of them. A careful study of some 
records seems to show that where the paroxysms can be con- 
trolled by chloral in large doses (sometimes in conjunction 
with the bromides) there is a shorter period of recovery in 
those cases in which the antitoxin has been administered. 
("Lancet," Nos. 3832 and 3842.) 

The value of serum-therapy in septic cases is also subjudice. 
In the cases reported the results have been very various, the 
diseases set up by the streptococcus pyogenes are generally of 
a very acute character, and there is often a general infection 
of the patient. W. Watson Cheyne, F.R.S.. Professor of Sur- 
gery at King's College, expresses the opinion ("Practitioner," 
April, 1897) "that experimental evidence is very strongly in 
favor of the view that anti- streptococcic serum ought to exer- 
cise a prophylactic action. Its use would not be confined to 
cases in which infection has already occurred, but its main 
utility will be as a prophylactic in cases where infection is 
likely to occur, more especially in cases of operations on the 
tongue and throat and about the rectum. In operations about 
the pharynx, tonsils and base of the tongue, septic pneumonia 
is a very frequent cause of death." In accordance with this idea, 
Mr. Cheyne had to operate on a case of carcinoma involving 
the base of the tongue, the anterior pillar of the fauces and the 
tonsil, with large glands in the anterior triangle of the neck, a 

PAPER. 273 

case in which septic pneumonia is extremely apt to occur. 
Two days before the operation, 20 c. c. of the serum was in- 
jected ; on the day before, 10 c. c. The operation consisted of 
a preliminary tracheotomy, removal of the glands in anterior 
triangle, ligature of the external barotid, splitting the cheek 
and removal of disease in the mouth and throat. The 
progress of the case was very remarkable. He says : ** It was 
the first time that I have seen in operations of this kind, that 
there were not at any rate, a few sloughs on the surface of 
the wound, but here the wound remained absolutely free from 
anything of the kind. The case healed without any trouble 
whatever." In two other cases of operation in extensive 
malignant disease of the mouth, the results were equally satis- 
factory. A large number of cases of septicaemia treated by 
anti-streptococcic . serum have been reported. The results 
have been so favorable in many cases as to warrant an ex- 
tended trial of the remedy. 

At a meeting of the Edinburgh Medico-Chirurgical Society, 
Dec. 16, 1896, Sir Thomas Grainger Stewart showed two 
patients, both young women, illustrative of the effect of strep- 
tococcus antitoxin in the treatment of recurrent erysipel- 
atous lymphangitis or Hutchinson's solid cjedema, following 
erysipelas. In the one case there was very great improve- 
ment, practically amounting to cure, while in the other case 
there was no reaction and no benefit. ("British Medical 
Journal," No. 1878.) 

Hernia Cerebri. — At a meeting of the Royal Medical and 
Surgical Society, held April 13, ult., a paper was read on 
fracture of the skull and hernia ceiebri, by R. Lawford Knaggs. 
It was based upon 109 collected cases. These plans of treat- 
ment should be followed : (i) Preventive, {a) asepsis j (^) 
thorough treatment of compound depressed fractures of the 
skull. The modern methods in these matters were probably 
the reason that so few cases of hernia cerebri were recorded in 
recent literature. (2) Non-interference^ This should be the 



rule, Rigid cleanliness should be observed and the tumor 
allowed to run its course. (3) Operative, Necessary when 
abscesses where present and should aim to evacuation, not 
mutilation. Apart from abscess, the necessity for it was ex- 
cessively rare, but as embedded fragments could now be 
diagnosed by skiagraph it was difficult to imagine a condition 
in which excision could be justified. In the following dis- 
cussion, W. Ballance remarked " that the occurrence of hernia 
cerebri was due to sepsis ; even when there was very extensile 
compound fi'acturc, if the wound was rendered thoroughly 
aseptic, hernia cerebri would not follow." He could not 
believe that the healthy dura mater would ever give way from 
increased intracranial pressure, but if softened by inflammation 
it might easily be perforated. 

Gunshot Wounds of the Head, — In a paper founded upon 
197 cases of gunshot wounds of the cranium, treated at 
Bardeleben's clinic, Tillmann remarks that primary trephining 
is indicated when there is considerable arterial hemorrhage 
and if symptoms of lateral paralysis or spasms are present. 
Later, this operation may be indicated when fever develops 
with lateral paralysis, and also when the presence of the ball 
in the wound has been ascertained. Otherwise it is better to 
wait, for, as a rule, the removal of bone chips will be impossible. 

Wounds of the Air Passages. — In a recent number of the 
" British Medical Journal," May 8th, ult., J. E. Piatt, F.R.C.S., 
Surgical Medical Officer, Manchester Royal Infirmary, con- 
tributes a paper founded upon an experience with 35 cases of 
suicidal wounds of the throat, in 10 of which the air passages 
were injured. From his experience he draws the following 
conclusions : 

1. Suicidal wounds of the throat should be treated by 
primary suture in all cases where the general condition of the 
patient permits. 

2. Antiseptic precautions are most important. 

3. Chloroform should be administered if necessary. It is 
perfectly safe. 

PAPER. 275 

4. The wound in the air passage should be completely 

5. If the wound of larynx or trachea is very extensive, or 
if the larynx be opened in the immediate vicinity of the vocal 
cords, it is better to employ a tube. In wounds of the thyro- 
hyoid membrane, if the epiglottis be extensively injured, it is 
better to perform laryngotomy or high tracheotomy before 
closing the laryngeal wound entirely by sutures. The tube, 
when found necessary, should be introduced through a fresh 
vertical cut in the air passage at a lower level. 

6. Silk is the best material* for suturing the larynx or 
trachea. Sutures should be all introduced before any are tied, 
and then the posterior one should be tied first. 

7. Divided muscles should be sutured, and in bringing 
together the edges of the skin the inversion caused by platysma 
muscles should be corrected. 

8. Drainage will usually be necessary. 

Wound of Heart and Pericardium, — In the " New York 
Medical Record,'* March 27, 1897, D. H. Williams records the 
following case : J. C, 24 years of age ; admitted into Provi- 
dent Hospital, Chicago, July 9, 1893, with stab wound about 
an inch long, three-quarters of an inch to left of sternum, 
through and in the long axis of the fifth cartilage. The wound 
was at first regarded as superficial, but during the night there 
were such persistent hemorrhage, pain over the cardiac area, 
cough and pronounced symptoms of shock, that an examination 
was made on the next morning, which showed that the knife 
blade had penetrated the fifth cartilage far enough to wound 
the internal mammary -vessels. The following operation was 
then performed : 

The original wound was lengthened to the right as far as the 
middle of the sternum. A second incision was made from 
the centre of the first and carried over the middle of the 
cartilage and fifth rib, about six inches in length. The 
sternum, cartilage and about one^ inch of the fifth rib were 
exposed. The cartilage of the fifth rib was separated at its 


junction with the sternum and at a point 2^ inches from the 
sternum and one-quarter inch from its attachment to the rib. 
The inferior attachments of the incised portion were separated^ 
leaving the superior ones in place. The incised piece was re- 
tracted upwards, making an opening about 2 inches long and 
i^ inches wide, bringing the internal vessels into view. The 
vessels were ligated above and below. To secure additional 
I'oom an incision was made in the fifth intercostal space. The 
heart and lung being depressed backwards, a small punctured 
wound of the heart was seen. This wound was about one- 
tenth inch in length and about one-half inch to right of 
the right coronary artery, between two of its lateral branches. 
There was no hemorrhage from the heart or pericardium. 
The wound in the pericardium was closed by a catgut suture; 
the parietal flap was replaced and the wound dressed. The 
patient, notwithstanding a sharp attack of pericarditis and 
pleurisy, made a complete recovery. Three years after he is 
reported as being well. 

Injuries of the Liver, — In the " Rev. de Chirurg.,*' Paris^ 
Terrier and Audray advocate very prompt exploratory lapar- 
otomy in all serious cases, with the objects of arresting actual 
hemorrhage, of preventing further loss of blood when such 
hemorrhage has apparently ceased, and, when the injury of the 
liver is complicated by a penetrating wound of the abdominal 
wall, of enabling the surgeon to explore the peritoneal cavity 
and to remove any possible source of infection. In the same 
number, Kousnetzoff and Pensky recommend the use of blunt 
needles for carrying sutures through hepatic tissue, in order to 
avoid lesions of the walls of the vessels ^nd consequent grave 
results. The bleeding may be arrested completely by tying 
very tightly but gradually the sutures passed through the liver 

In the ** Beitrage zur Klinischen Chirurgie," Band XV., Heft 
II., 1896, Dr. Schlatter, to the cases already reported, adds five 
of his own ; 

I. Stab wound of liver. Prolapse of colon and omentum ; 

PAPER. 277 

profuse hemorrhage from the liver ; wound about one inch 
wide and so deep that finger-tip failed to reach the bottom ; 
two deep sutures of heavy catgut and two capsular sutures of 
fine silk ; recovery. 

2. Gunshot (revolver) wound of liver. Severe hemorrhage; 
three deep sutures of heavy catgut checked the bleeding, and a 
good recovery was made. 

3. Gunshot wound of liver by Flobert projectile. Track 
of bullet involved the stomach, ileum, pancreas and left 
kidney ; patient 17 years old and liver tissue friable ; six deep 
«ilk sutures stopped hemorrhage ; death after eight hours. 

4. Rupture of liver and right kidney. Two days before 
operation. Suture of liver ; hemorrhage stopped ; saline 
injections ; death. 

5. Almost complete sagittal rupture of left lobe of liver ; 
profuse exudate of bile into peritoneal cavity ; laparotomy 
and suture of liver fourteen days after injury ; death. 

In only one of these cases was there a tendency for the 
sutures to ciit through the tissue. In this case silk instead of 
catgut was used, and the tissues were more friable than those 
of the others, who were all adults. The results, as far as 
checking hemorrhages was concerned, were satisfactory. The 
combination of deep catgut sutures of large size with fine silk 
superficial suture of the capsule is recommended. The tampon 
should be used only when sutures have failed to control the 
hemorrhage. Thermo-cautery is the least valuable of the 
methods ; it will check only moderate parenchymatous hemor- 
rhage, is of no value in extensive wounds and is apt to be 
followed by secondary hemorrhage. In cases of subcutaneous 
rupture, where there gradually develop symptoms of internal 
hemorrhage, the differential diagnosis may be impossible. Shall 
the surgeon leave the patient to his fate ? The concensus of 
opinion is against it. Which is the most favorable site for an 
incision ? If the site of the injury is the left lobe or is 
undetermined, a median incision should be made ; in wounds 
of the right lobe, a curved incision along the lower border of 


the costal cartilages and to the right of the rectus muscle is 
to be preferred. In some cases these may be combined, form- 
ing an angular incision. ("Annals of Surgery," April, 1897.) 

In the " Lancet," for May 8, 1897, Christopher Martin, M.B., 
Edinburgh, and F.R.C.S., England, Surgeon to Birmingham 
and Midland Hospital for Women, reports a case of rupture 
of liver. The patient was a miner, 19 years old and received 
a "rolling crush" between two trucks down in the pit. Thirty- 
four hours after the injury, in a miner's cottage, by the uncer- 
tain light of a paraffin lamp, laparotomy was performed. 
There was an immense quantity of blood in the abdomen. 
The liver was found to be ruptured. A rent one to two inches 
deep ran from before, backwards on the under surface of the 
right lobe, from the portal fissure as far up the posterior sur- 
face as could be reached. Abdomen was flushed with hot 
water. Floating among the clots was a fragment of liver 
substance wholly detached. The wound was so extensive that 
suturing was impossible, and it was concluded to rely on the 
hemostatic effect of hot water, by means of free irrigation of 
the abdomen, thorough removal of all effused blood from the 
abdominal cavity and free drainage. A short incision was 
made just above the pubes and two drainage tubes of glass were 
inserted, one through the epigastric incision to the liver, and 
the other into the pelvis. Drainage was continued for a 
number of days. The patient gradually recovered. 

Operation for Perforation of Gastric Ulcer. — The journals 
of comparatively recent issue contain a number of accounts of 
cceliotomy for perforation of stomach following ulcer. The 
very favorable percentage of successes makes it obligatory on 
the attending physician to give the patient the chance of 
recovery. Indeed, it seems criminal to hesitate or delay. As 
suggestive, abstracts are herewith given of five cases contained 
in Nos. 1885 and 1893 of the " British Medical Journal." 

Thomas H. Mose, F.R.C.S., England, of Norwich, contri- 
butes three cases, two of them successful. The first was 
operated on five hours after the first onset of symptoms. Case 

PAPER. 279 

2 was operated on four and one-half hours after the onset of 
symptoms. The abdomen was freely irrigated in both cases. 
The first made a rapid, uneventful recovery. The recovery of 
the second was delayed by the formation of an abscess in the 
left pleural cavity, which was opened and drained from the 
back. The third case was operated on twenty-four hours after 
the onset of symptoms. Patient was deeply collapsed, knees 
drawn up, abdomen tympanitic, liver dulness absent. The 
perforation was closed. She never rallied, dying a few hours 
after the operation. 

In a case occurring at St. Thomas' Hospital, reported by 
Herbert P. Hawkins, M.D., F.R.C.P., and C. S. Wallace, B.S., 
F.R.C.S., the patient was operated on more than fifty hours 
after the onset of symptoms. The perforation was closed and 
abdomen thoroughly irrigated and drained, qne tube being 
introduced through an opening made for the purpose below 
the umbilicus. On the third day after the operation, a double 
parotid bubo appeared. On the sixteenth day the temperature 
began to rise and two days later the patient passed two ounces 
of pus by the rectum. On the twentieth day temperature 
rose to 104.4 ^^^ thrombosis of the deep veins of left leg set in. 

Another case reported from St. Thomas* Hospital by G. H. 
Makins, F.R.C.S., and S. G. Toller, M.D., M.R.C.P. Patient 
was operated on twenty-four hours after onset of symptoms. 
On the sixth day after operation temperature rose, and in the 
course of the afternoon she was seized with considerable dysp- 
noea, suggestive of pulmonary embolism. The attack passed 
off in an hour, but in the next few days consolidation of lower 
lobe of left lung appeared with slight fever. She made a 
good recovery. 

These cases were all females, of whom four recovered. The 
patient who died was operated on fifty hours after onset of 
symptoms. Even in those operated on soon after onset of 
symptoms, secondary infection occurred, abscesses or throm- 
bosis occurring in various parts of the body. 

Perforating Typhoid Ulcer, — Jno. T. Finney, M.D., Associ- 


ate in Surgery, Johns Hopkins University, contributes an 
article on this subject to the March number of " The Annals 
of Surgery," founded on the collation and comparison of 47 
cases of perforating typhoid ulcer, surgically treated. Of 
these, thirteen recovered, a percentage of 27.65. This is a 
very cogent argument in favor of operative interference. 
Conceding the wisdom of the operation, how should it be 
done ? Finney's method has proved most satisfactory. An 
oblique incision in the right iliac region, as for appendicitis, 
about six inches long. Find the caecum, draw out coils of 
ileum through the abdominal wound. Let an assistant wipe 
with a gauze sponge wrung out of hot salt solution, the 
intestine as it is withdrawn and another assistant keep it 
covered with warm salt sponges or towels. All the infected 
intestine should be drawn out of the peritoneal cavity. Then, 
with large gauze abdominal pads and sponges wrung out of hot 
salt solution, carefully and systematically wipe out the perito- 
neal cavity until microscopically clean, paying special attention 
to the pelvic portion. It is not usually necessary to irrigate 
with salt solution to do this. Next, uncover the intestines and 
irrigate them thoroughly while outside the abdomen with hot 
salt solution ; then begin to replace them in the inverse order 
from that in which they were withdrawn, being careful to wipe 
them dry and free them thoroughly from flakes of lymph, 
faecal matter, etc. The worst coil should be the last replaced 
and the sutured portion next the abdominal wound. 

This should be packed about with strips of bismuth gauze 
and a strip introduced into the pelvis if necessary. By pack- 
ing about the worst or sutured coil and leaving it superficially 
placed, you insure good drainage, and provide for the escape 
of extravasated faecal matter, if any such extravation should 
take place. Then close the abdominal wound, except a small 
opening for the gauze drain to come through. If there is 
much distension, the bowels should be moved early and 
thoroughly by calomel in broken doses, followed by salts, and, 
if necessary, a high turpentine and soap-suds enema. Dr. 

PAPER. 281 

Finney remarks, finally : If I were to sum up my impressions 
formed from a study of this series of cases, and from my own 
experience in the management of the conditions presented, it 
would be somewhat as follows : 

(1). Of all the diagnostic signs of perforating typhoid ulcer, 
most reliance is to be placed upon the development of an 
attack of severe, continued abdominal pain, coupled with 
nausea and vomiting, and at the same time a marked in- 
crease in the number of white corpuscles. 

(2). The surgical is the only rational treatment of perfor- 
ating typhoid ulcer. 

(3). There is no contra indication to the operation, 
surgically speaking, save a moribund condition of patient. 

Armstrong (British Medical Journal, Dec. 5, 1896,) refers 
to three cases in which he had operated unsuccessfully and to 
one in which recovery had taken place. Of 23 cases collected 
by him, where typhoid was certain, recovery took place in four. 
If there is clinical evidence that the perforation is in the colon . 
or that it is likely to remain localized, then he would advise 
waiting for abscess formation. If, on the other hand, the signs 
point to a perforation into the general peritoneal cavity, 
previous to the formation of living adhesions, laparotomy, 
suture and thorough irrigation of abdominal cavity and very 
free drainage offer the only hope. Interference should not be 
undertaken until the condition of collapse has passed off. 
Perforations occurring during convalescence offer greater 
prospects of recovery. This is sustained by a case presented 
by Drs. Lauder Brunton and A. A. Bowlby to the Royal Medi- 
cal and Surgical Society in January last. Symptoms of perfor- 
ation developed suddenly about a month after convalescence 
from typhoid. Abdomen was opened eighteen hours after 
onset of pain. Recovery was uneventful. 

In the "Boston Medical and Surgical Journal," Francis S. 
Watson, M.D., reports a case of recovery after laparotomy and 
intestinal suture for perforating typhoid ulcer. 

Mr. Greig Smith, in "Treatment," for Mar. 25, 1897, urges 


the desirability of withholding opium in cases of grave abdomi- 
nal disease. He advises the avoidance of iced fluids lest the 
intestines may be started into furious action by their admin- 
istration. Assuming that a patient has symptoms coming on 
suddenly which may be due to simple colic or to some grave 
condition, such as obstruction or perforation of a viscus, or 
even extravasation of blood, the first thing to be done is the 
administration of brandy in milk by rectum and swathing the 
patient in hot blankets. The attendant then sits down to 
watch him and complete the diagnosis. The patient makes a 
great fuss with a colic,but the subject of grave disease makes little 
fuss and keeps his abdomen as still as possible. If the intes- 
tines are in motion, there is no perforation, because this causes 
paralysis and silence on auscultation, except at the seat of 
rupture where there are rare and mysterious blowing or rush- 
ing sounds. Mr. Greig Smith then refers to the signs of 
gaseous exudation into the peritoneal cavity. 

In the 78th volume of the " Medico-Chirurgical Trans- 
actions," Messrs. Edmunds and Ballance have recorded a very 
interesting and important series of experiments and observa- 
tions on intestinal and gastro-intestinal anastomosis. The 
experiments were made on dogs. 

Lateral-anastomosis by Senn's plates. It was found after 68 
days that the union had become practically end to end. In 
another series of experiments, the parts retained the lateral 
position after 63 days. Mayo Robson's bobbin was used only 
once and the opening was very small 33 days after the opera- 
tion. Still it was sufficient. Murphy's button was used, only 
once, but the button was too large and the animal died. Sutur- 
ing by Halstead's method produced good results and large 
openings. In five cases the Czerny-Lembert suture was used 
successfully, but there was a circular ridge at the line of junc- 
tion which constitued a diaphragm and diminished the lumen 
of the bowel. After using Maunsell's method, the experimenters 
found no such diaphragm. Union was so perfect that it was 
difficult to recognize the line of circular junction. 

PAPER. 283 

Appendicitis, — In the ** Medical Record," January 9,1897, 
Dr. Geo. F. Shrady lays down rules for operating in appendi- 
citis* They embody the conservative opinion of the day, a 
reaction from the trend of thought of two or three years ago. 

(i). A continuously frequent or progressively accelerated 
pulse is of itself, even in the absence of any other dangerous 
symptoms, an indication for operation. The actual number of 
pulse beats is not of so much account as their tendency to 
increase, although the rule laid down by Willy Meyer, to 
operate when the pulse reaches 116- 120, is generally a trust- 
worthy one. 

(2). Pain, localized and progressive, is a valuable associ- 
ated condition. When pain is sudden, severe and progressive 
and accompanied with a chill, it means perforation or rupture 
of abscess and demands immediate operative interference. 

(3). Increase of temperature is third in importance, but 
when associated with one or both of the previously noted 
symptoms, especially the first, it makes immediate operation a 
foregone conclusion. 

(4). The gradual subsidence of the three cardinal symp- 
toms, pulse rate, pain and temperature, is a legitimate reason 
for postponing operative interference. 

(5). In cases of abscess it is generally safer, while watching 
for urgent indications, to wait until adhesions have formed a 
sufficiently protective wall. 

In the fulminating cases, the sudden agonizing pain first 
localized and then becoming general, the rapid thready pulse, 
the pinched face, hurried, grunting respiration, increased 
temperature and abdominal distention, are of such grave 
significance as to leave no place for arguments. 

Jarvis S. Wright, M.D., LL.D., recommends an incision for 
appendictomy, beginning nearly on a level with the ant. sup. 
spine of ileum, curving inward and a little upward from a 
line parallel to Poupart's ligament and is made about two 
inches in length. It is usually about one-third the distance 
from ant. sup. spine to umbilicus. In a case of post-caput 


appendicitis the surgeon can reach the pus cavity with greater 
certainty and safety, not only at time of operation, but it also 
facilitates the attempt to find the appendix in case it is 
located higher up or lower down in the abdomen than usual. 
When we find the caput coli we are near the appendix. There 
is less danger of wounding the adjacent intestines, less 
tendency to prolapse of omentum and ileum. The inner flap 
can be well drawn toward the median line for the purpose of 
thorough exploration. This enables the surgeon to wall off 
the general peritoneal cavity with facility and certainty. It 
affords excellent drainage at time of operation as well as sub- 
sequently. An appendicular abscess can be opened on its 
outer aspect in such a way as to prevent infection of peritoneal 
cavity. In a great many cases it gives the best opportunity 
to find and amputate the appendix. It is favorable for 
primary union. The repair following the hypogastric incision 
has not been followed by venetal hernia. ("Amer. Med.-Surg. 
Bulletin," Mar. lo, 1897.) 

Intestinal Anastomosis, — In the '* Lancet " for May 22, 
1897, G. Lenthal Cheatle, F.R.C.S., Assistant Surgeon to 
King's College Hospital, etc., makes a preliminary report on a 
method of uniting the divided intestine. After removal of 
the affected segment of the intestine by a section exactly 
transverse to the longitudinal direction of the bowel and its 
V-shaped piece pf attached mesentery, the open ends of the 
gut lie requiring suture. Through all the coats forming the 
wall of each free end, a longitudinal incision is made, and in 
each case it should be situated exactly opposite that part of the 
bowel to which the mesentery is attached. The length of each 
incision must vary as convenience and necessity demand, but 
speaking generally it should be at least equal to the diameter of 
the tube at the seat of resection. These incisions allow the 
open ends of the intestines to spread out in the shape of a fan, 
and while in that position the separated serous surfaces can be 
exactly apposed, as it were, back to back. An assistant should 
now hold the intestinal extremities in this accurately adjusted 

PAPER. 285 

position during their final fixation. The first suture should fit 
in apposition the mesenteric attachments ; the two next should 
likewise accurately join the respective extremities of the fan- 
like expansion. The rest of the stitches may be inserted with 
greater exactitude. Each must be well tightened at the first 
knot ; all coats of both epds must be transfixed by the silk- 
bearing needles, and the needles and silk employed must be 
the finest that are compatible with safety. The ends are thus 
firmly joined and all that remains to be done is to suture 
the longitudinal incision by any of the well-known methods. 

This method permits the union of the large to the smaller gut. 
The only addition necessary to accomplish the junction occurs 
after the small intestine has been sutured to the colon in the 
manner described. Then there will be found on each side of 
the joined intestines, two equal-sized superfluous flaps of the 
large intestine. A portion of each of these flaps can be cut 
away in a V-shape, so that the apex of the V is exactly in a 
line with the preliminary incision into the free end of the 
small intestine, opposite the meso-colic attachment. The 
remaining superfluous parts of these two edges can be inverted 
by Lcmbert's suture. The result will be that the colon tapers 
to its union with the ileum. The longitudinal incisions are 
then closed with Lembert's suture. 

Treatment of Fractures, — For several years past the atten- 
tion of surgeons all over the world has been directed to 
improving the methods of treating fractures, for the purpose 
of hastening union of the fragments, of diminishing the ten- 
dencies to partial false anchylosis where the fracture is in the 
vicinity of joints and the organization of blood clots, of 
preventing thickening of joints by exudation, of preventing 
atrophy of muscles and disturbance of the circulation — the 
object being, in short, to rapidly restore junction and maintain 
and improve the patient's general condition during the period 
of treatment. Interest in the subject was greatly increased 
by a discussion of the "Ambulatory Treatment of Fractures," 
at the twenty-third congress of German surgeons, held in 


Berlin, in 1894. This plan enables the patient to walk on the 
sole of the plaster splint without any external support, the 
plaster being so applied as to act, as Woolsey says, as a com- 
bination of extension splint and artificial leg. Its advantages 
are that it maintains the general condition of the body and is 
especially useful in the aged and alcoholic by obviating long 
confinement in bed. It prevents atrophy and stiffness of the 
remoter joints and enables certain classes of cases to resume 
business. But it does not materially shorten the time of heal- 
ing. It fails in maintaining or restoring the functions at the 
time when union is obtained. To obviate these difificulties, 
Lucas Championniere, a distinguished French surgeon, advo- 
cates massage and mobilization, and supports his contentions 
by a most able and exhaustive treatise published last summer. 
Championniere declares that only the primary pain due to 
movement of the fractured ends on one another i» relieved by 
immobilization, and then not entirely until callus binds the 
ends together ; that it allows and favors a secondary pain in 
the neighboring muscles, joints, etc., which is largely due to 
the swelling from ecchymosis and cedema. 

2. He shows that the statement that the restoration of the 
member to its original form is accomplished by immobilization 
is only relatively true, and especially so in the most important 
fractures, /. ^., at the ends of bones, in which consolidation 
often takes place in a form different from the primitive one. 
Reduction only corrects the displacement imperfectly in many 
cases, and the latter may be reproduced by serous or bloody 
extravasations or faulty apparatus. 

3. That instead of favoring the repair of bone, immobiliza- 
tion favors a scantiness of callus. 

4. That immobilization is the worst instead of the best 
condition to assume the recovery of normal function. 

5. That inflammation depends upon bacterial infection and 
not on movement. 

Championniere adds that absolutely exact return to the 
original form after a fracture is not as important as the 

PAPER. 287 

complete return of the functions of the joints, muscles, etc. 
As to massage, he says : 

1. A certain amount of motion is favorable to the repair 
of bone. 

2. Massage is complex therapeutically. It gives a favorable 
degree of movement, and by many unknown ways causes the 
repair of bone to be rapid and regular. 

3. Certain degrees of deformity contra-indicate the imme- 
diate application of massage. Movement should be made by the 
surgeon and not in connection with the function of the part. 
Made by the surgeon it is useful from the very beginning of 
treatment. Massage is the best means of causing slight move- 
ments without pain at the seat of fracture and is, according to 
Championniere, the fundamental principle of treatment. It 
should relieve pain, not cause it ; it should reduce swelling ; it 
keeps muscles from atrophy, the joints and tendons from stiff- 
ness, the skin soft and supple, and the return of the part to 
vital activity is rapid and satisfactory. Contra-indications. — 
Large or numerous blebs, until they are dried up ; a sharp 
fragment threatening to perforate the skin or open vessels; 
extreme mobility of the fragments. 

George Woolsey, M.D., Surgeon to Bellevue Hospital 
(" Medical News," March 20, '97), believes that a combination 
of the advantages of the ambulatory and massage treatment 
can be obtained. In his service in Bellevue it has become the 
routine plan. By it he has treated thirteen cases of Potts' frac- 
ture, with three under treatment at time of writing article. 
Bony union is obtained by the end of third week. The 
patients are permitted to get up from the nineteenth to the 
twenty-fifth day, and able to walk without cane within two or 
three days with little or no stiffness or pain. Dr. Woolsey 
draws the following conclusions : 

I. The treatment of fractures, especially those near joints, 
by immobilization, whether ambulatory or not, leaves some- 
thing to be desired in (a) the time required and (^) the func- 
tional result obtained. 


2. The treatment of such fractures by massage and passive 
motion shortens the time of bone union by one-third or one- 
half, and vastly improves the immediate functional result. 

3. This treatment is especially applicable and important in 
fractures near joints. 

4. Its application is easy. It relieves pain and swelling, 
hastens callus and solidification, prevents atrophy of muscles 
and stiffness of the joints and tendons. 

^. Splints should be applied between the daily fifteen or 
twenty-minute application of massage for the first ten or twenty 
days, according to the nature of the fracture and the tendency 
to displacement, or until consolidation occurs. 

6. This treatment, combined with the ambulatory methods, 
promises to be an ideal method. 

7. Oblique fractures of both bones or the only bone of a 
limb, or fractures near the middle of the limb with a tendency 
to displacement, , should be immobilized until consolidation 
has commenced. 

8. The ambulatory treatment is indicated in the latter class 
of cases, in fractures of the lower extremities in the very 
aged or in the alcoholic, and in fractures in the neck of the 
femur in the aged. 

9. The plan of immobilizing the limb for a short time in 
the best possible position and then applying massage and 
passive motion, promises equally good results, and especially 
adapts the method to private practice, in which it is particularly 
indicated on account of the shortened time for union and the 
excellent functional results. 

In an article in " The Practitioner " for March, last, A. G. 
Miller, M.D., F.R.C.S., England, Surgeon to Royal Infirmary, 
Edinburgh, takes substantially this position. 

Gwylim G. Davis, M.D., F.R.C.S., England, Surgeon to 
German, St. Joseph's and Orthopoedic Hospitals, Philadelphia, 
contributes to the "Annals of Surgery," for December, '96, an 
excellent article on this matter. He summarizes his conserva- 
tive paper in this way : 

PAPER. 289 

. I. Massage and passiv<5 motion are not used to the extent 
they should be in the treatment of fractures. 

2. Immobility of fractured ends favors quick union, with 
little deformity. 

3* In some cases, owing either to peculiarities of the 
fracture or the impaired constitution of the individual, the 
tendency to the formation of callus is nfarked. Motion in 
these tends to formation of exuberant callus and deformity. 

4. In other cases bony union is unduly delayed. Disturb- 
ance of fractured ends hinders union. 

5. It is wise to wait until the parts are glued together, 
usually eight or ten days, before attempting any except the 
lightest massage, and any passive motion after that time should 
be used carefully but diligently. His other conclusions co- 
incide with the rules already laid down in this abstract. One 
suggestion of his should be noticed, viz.: the use of the local 
hot air bath in limbering stiff and contracted extremities. 

Dragon (Epitome "Brit. Med. Journal," March 20, '97) 
publishes the results of massage applied to twenty cases of 
fracture of clavicle under the care of Lucas Championniere. 
He practices daily massage, not only at the seat of fracture, 
but also of the adjacent joints and muscles, and insists particu- 
larly on massage of the deltoid and careful movements, both 
active and passive, of the shoulder. In the intervals the 
upper limb is supported by a sling. Consolidation of frag- 
ments is usually effected between eighteenth and twenty-fifth 
days, and at the end of the period the patient is able to use 
the limb freely. Result is functionally perfect. 

In a paper prepared for the Second Pan-American Congress, 
John B. Roberts, M.D., Prof. Surgery Phil. Polyclinic, etc., 
advocates exploratory incision in those cases of fracture and 
dislocations in which satisfactory coaptation is not obtainable 
under anesthesia. He limits his advocacy of cutting down 
upon closed fractures to cases in which ignorance of the exact 
lesion, impossibility of reduction, imperfect immobilization, a 



failure to deal efficiently with complicating lesions make the 
incision the less of two evils. A similar method of dealing 
with luxations which are not readily reduced by manipulation 
under anesthesia is, in my opinion, preferable to long continu- 
ance of unsuccessful manipulations, the application of great 
power by apparatus, or a relinquishing of the attempt to 
restore the integrity of the joint. (" Medical News," January 
i6, 1897.) 

Out of twelve cases of pseudo-arthrosis operated upon at 
Brun's clinic in the last few years, seven were caused by inter- 
position of muscles. Hence it must be recognized that this is a 
very frequent cause of pseudo-arthrosis. Crepitation was absent 
in six cases. All recovered after removal of the muscle inter- 
posed. Permanent interposition of muscle is an absolute bar 
to consolidation. The diagnosis is at times very difficult. The 
only positive diagnostic sign is absence of crepitation. There- 
fore, it is imperative, especially in fractures of the thigh and 
forearm, to elicit undoubted crepitation with the aid of nar- 
cosis. ("American Med. Surg. Bulletin," Feb. 10, '97. Ab- 




. I 

- , 1 

in Mtm$viam^ 


Bom February '22, 1S38. - • 
Died June 11, 1996. 


Born August 27, 1829. 
Died January 25, 1897. 


Bom November 2, 1844. 
Died April 2, 1897. 


Bom October 27, 1850. 
Died February 13, 1897. 


Bom September 13, 1826. 
Died February 27, 1 897. 

£n iitemorlam. 


Bom November i6, 1858. 
Died February 14, 1897. 


Born September 28, 1855. 
Died April 5, 1897. 


Born , 1 82 1. 

Died July 7, 1896. 


Bom August I, 1856. 
Died July 20, 1896. 




Dr. Julius M. Simpson was born in Canada, Feb. 22, 1838, and 
died at his home in Schraalenburgh. June, 11, 1896. The following 
testimonial was adopted at the annual meeting of the District Medi- 
cal Society of Bergfen County : 

By the death of J. M. Simpson, M.D. the Bergen County Medical 
Society has lost from the roll of its membership, one, who during an 
active professional life of a quarter of a century, was closely identified 
with its interests. He was a regular attendant upon its principal 
meetings, a contributor to its papers, a recipient of its honors and 
an incumbent of its offices. He was unusually free from serious 
faults and enjoyed an unblemished reputation in private life. His 
character was rounded out by his thorough belief in Christianity, and 
his usefulness and influence were increased by his acceptance in 
mature life of its personal claims. A hearty recognition by the Medi- 
cal Society of the loss of such a member is eminently proper. 
Therefore, be it 

Resolved, That in the death of Dr. J. M. Simpson, the Bergen 
County Medical Society has lost an old respected and useful mem- 
ber. That the medical profession has sustained the loss of a modest, 
conscientious, industrious and successful practitioner of the healing 
art. That the community, of which he was an honored member, has 
lost a man of public spirit and wise counsel. That our sympathies go 
out in an especial manner to the family circle providentially stricken 
by the comparatively early death of a husband and father. 

Resolved, That this preamble and these resolutions be filed with 
the archives of the society, and that a copy of the same be forwarded 
to the family of the deceased. 



Dr. Thomas Garwood Rowand was the son of Dr. Joseph F. 
Rowand and was born at Carpenter's Landing, Gloucester County, 
August 27, 1829, and died at his residence in Camden, January 25, 
1897, of oesophageal stenosis, in the sixty-eighth year of his age. The 
paternal ancestors of Dr. Rowand emigrated from Scotland in the 
seventeenth century and took part in the early colonization of 


Virginia. His maternal ancestors were members of the famous 
Fenwicke Colony, so justly celebrated in the early settlement of West 
Jersey, under the leadership of Jbhii Fenwicke. 

At an early age. Dr. Rowand began the study of medicine under 
the direction of Dr. James McClintoek.-one-of the most distinguished 
surgeons, at that time, in Philadelphia, and while a student, rendered 
voluntary and efficient service at the South wark Cholera Hospital in 
the cholera epidemic of 1849. Dr. Rowand was graduated from the 
Philadelphia Medical College in 1850, and assisted, for a time after- 
wards, in the work of college clinics. He subsequently practiced 
medicine in Philadelphia, Lumberton and Beverly. In 1852 he 
moved to Camden and opened a drug store at themorthwest comer of 
Fifth and Federal Streets, and abandoned the exacting duties of the 
medical practitioner for the easier work of the pharmacist. This store 
was moved subsequently to the northeast comer of Fifth and Federal 
Streets and has become one of the pharmaceutical landmarks of the 

In 1854, Dr. Rowand was elected coroner of Camden County and 
was the first physician to hold that important position. He was re- 
elected coroner in 1868. In 1857 he was commissioned by Governor 
William A. Newell (a distinguished physician of Monmouth County 
as well as governor of the State) quartermaster of the Camden Militia 
Brigade, an organization that remained active in the State forces until 
the establishment of the present National Guard, in 1869. In 1859, 
Dr. Rowand was elected Professor of Materia Medica, Pharmacy and 
Therapeutics of the Penn Medical University of Philadelphia, and 
was the youngest medical lecturer in that city. This position he 
retained until the close of the college term in i860. 

At the breaking out of the Civil War in 1861, Dr. Rowand took an 
active part in politics and served as one of the secretaries at the great 
war meeting held in Camden on April 18, of that year, for the purpose 
of supporting the proclamation of President Lincoln. In September, 
1862, he wa§ commissioned First Lieutenant and Assistant Surgeon 
of the Twenty-fourth Regiment, N. J. V., on the staff of Colonel 
William B. Robertson. Drs. William L. Newell, Alban Williams and 
Thomas G. Rowand served as medical officers of this regiment. The 
regiment was mustered into the United States' service September 16, 
1862, and was assigned to the Second Army Corps. Dr. Rowand 
participated with his regiment in the battles of Fredericksburg and 


Chancellorsville, where he rendered distinguished service. Hon. 
John Y. Foster, in his work " Hew Jersey and the Rebellion," quotes 
an officer of the regiment as sa3ring : 

" Among the most indefatigable in looking after and administering 
to the wants of the sick and wounded of the regiment, after the 
battle of Fredericksburg, was our faithful Chaplain, Rev. William 
C. Stockton. Nor can too much commendation be awarded to our 
Surgeon, Dr. W. L. Newell and his assistants, Drs. Williams and 
Rowand, and likewise to Dr. Jesse B. McBride, who was detached 
from Company F to act as Hospital Steward, and who was engaged 
all day Sunday in attending to the wounded." 

Following the battle of Chancellorsville, Dr. Rowand was detailed 
as one of the surgeons to the Third Division, Second Corps Hospital, 
Potomac Creek, where he remained until the expiration of his service 
and the mustering out of his regiment in June, 1863. Upon retiring 
from the army. Dr. Rowand opened a drug store in Camden and took 
an active interest in the political and educational affairs of the city> 
In 1865 he was elected a member of the board of education and 
served as president of that body in 1867 and 1868. In 1874 he was 
elected a member of the Camden County Medical Society, but never 
actively engaged in the practice of his profession after the expiration 
of his term of service in the army. With the affairs of. th^ Grand 
Army of the Republic, Dr. Rowand maintained a close interest and 
at the organization of William B, Hatch Post, of Camden, he was 
elected its surgeon. 



' Charles R. Wiley, M.D., was born at Goshen, Cape May County, 
N. J., November 2, 1844 ; graduated at Jefferson Medical College in 
1865, 2md settled at once in Vineland, Cumberland County, where he 
practiced continuously, scarcely ceasing for a single day except when 
compelled by serious illness, until he died, April 2, 1897. 
' Although a general practitioner in the most literal sense. Dr. 
Wiley found his favorite specialty in the treatment of diseases of the 
^lose and throat. For tenor twelve years of his later life he did a 
great deal of this work, drew many patients from far distant points 
aiid had many brilliantly successful results beyond the . ordinary 


routine. In this, as in everything else, he was always abreast of the- 
times, fully conversant with the latest methods and equipped with the 
most improved instruments and appliances. During the most active 
period of his outside practice, he did an exceptionally large obstetric- 
business, and later was frequently called as consultant in difficult 
cases. He often said that the worse they were the better he liked 
them. As a general surgeon, within, of course, the limits imposed 
upon practitioners so near a great city, he also ranked high. 

Personally, Dr. Wiley was a whole-soled, open-hearted man,, 
generous to a fault, a hard fighter and a strong friend. His mild 
eccentricities, of which he had, perhaps, no more than other physicians^, 
never prevented him from being kindly and considerate in the sick 
room or in social intercourse. In everything he did he was enthusi- 
astic, and was, until ill-health overtook him, wonderfully full of life 
and vigor and with a tremendous capacity for, and love of, his work. 
In spite of his busy life as a physician he found time and strength for 
many other things. He was a member of several secret orders, was- 
long one of the most influential members of Borough Council, and at 
the time of his death was a director of the Tradesmen's Bank and 
trustee of the First M. £. Church, besides his professional positions- 
as President of the Pension Examining Board for Cumberland 
County, and consulting physician to the Training School for Feeble* 
minded Children. 

He was a Democrat, heart and soul, and every campaign, national 
or local, brought out a real earnestness seldom seen. It may be 
truly said of Dr. Wiley, as he would have wished it to be said of him,, 
that he died in the harness. Beginning with a poisoned hand and arm,, 
contracted in dressing a purulent wound some four or five years 
before his death, his health gradually broke down. Several attacks 
of the grippe and an ulcerated leg, which, for a year or more, necessi- 
tated the almost constant use of crutches, made it a hard struggle to 
keep up, with constantly lowering vitality. 

In March he was again attacked by the grippe, but there were then 
many dangerously sick and he kept at work till he was forced to bed 
by an attack of acute pneumonia to which he succumbed in a week, 
being, after the first day, unconscious most of the time. Dr. Wiley 
had hosts of friends, both lay and professional, who mourn his loss ; 
but next to his own kin, those who feel it most keenly are the 
sufferers, and most of all the poor and unfortunate ones among them,. 


who looked to him for help in their hour of need, who expected and 
received, night or day, storm or shine, for thirty-two long years, 
always the pleasant smile and cheery word as well as tender sympathy 
and skillful care. 



Dr. William Raby Little was born at Charlestown, Chester County, 
Pa., October 27, 1850, and died at his home in Bloomsbury, N. J., 
February 13, 1897. - 

Dr. Little was the son of William and Ann Little. He attended 
Little's School, in Charlestown, the Sconneltown Public School and 
Litiz Academy, in Lancaster County. Pa. He was graduated as 
civil engineer from Lafayette College, in 1873. Later he began the 
study of medicine and was graduated from the medical department 
of the University of Pennsylvania, in 1878. 

Dr. Little located at Bloomsbury. Hunterdon County, N. J., in 
1878, where he practiced until his death. He was a member of the 
American Medical Association, the Medical Society of New Jersey, 
and the Hunterdon County Medical Society. He was elected a 
coroner for Hunterdon County, in 1896. 

Dr. Little was married to Celia Creveling, of Bloomsbury, N. J., 
who died in 1891, leaving one son, William Darlington Little. His 
second wife was Clara Campbell, of Bethlehem, Pa., who died in 
1895. Dr. Little was suddenly taken ill on February 9, 1897, while 
engaged in active practice, with pleuro-pneumonia, and died four 
days later. His large and sad funeral on the 17th, attested his great 
worth, being attended by his order, Bethlehem Lodge F. & A. M., 
Hunterdon County Medical Society, and a large concourse of citizens. 
He was buried in the cemetery of the Bloomsbury Presbyterian 
Church, in which he was an elder at the time of his decease. 

As a member of the Hunterdon County Medical Society, Dr. Little 
was rarely absent from its meetings, where his loss is particularly 
felt by reason of being an active participant in all of its proceedings. 
Frequently, he represented his local society at the meetings of the 
State Society. 

Dr. Little was a man of pleasing presence, agreeable manners 
and fine attainments, which qualities endeared him to those with 


whom he came in contact. He was a constant student and very 
earnest in the work of his profession, to which his loss is deplorable. 
He was ever courteous and affable to his fellow-physicians, and a 
conservative, skillful and successful practitioner. 


Dr. Kirby was born near Swedesboro, N. J., Sept. 13, 1S26, and 
.died in Trenton, of apoplexy, Feb. 27, 1897. 

The following memorial was adopted by the District Society of 
Mercer County : 

The District Society of Mercer County, having been informed of 
the death of one of its oldest and most respected members, has con- 
sidered it eminently fitting to place on record a testimonial of our 
sentiments in regard to our loss and our estimate of the character of 
the late Dr. John Kirby. 

Dr. Kirby was a graduate of the University of Pennsylvania, in 
the class of 1852, and practiced medicine in the City of Salem, N. J., 
for nearly twenty-five years, and during all that time, the testimony 
of those who knew him best, is one of love and veneration. His 
patients came to look upon him as one of their dearest friends, and 
when he left his active practice and came to Trenton, there was an 
universal expression of regret among them. In his business relations 
with his fellow-citizens, he was always regarded as the soul of honor, 
and his reputation for truthfulness extended to all classes. 

Upon taking up the duties of assistant physician to the New 
Jersey State Hospital, Dr. Kirby brought to bear the very best quali- 
fications for one assuming such an important position. Under the 
most trying circumstances, he was brave, patient and uncomplaining. 
One who knew him well, and was closely associated with him for a 
long time, says, in writing of him : " I regarded him as one of the 
most upright, honorable and altogether admirable men it has ever 
been my good fortune to meet." And this is not an exaggerated 
opinion, although the quiet, unobtrusive manner of Dr. Kirby kept 
him often in the background, when others of less merit became more 
prominent. As members of this Society, we consider that we have 
lost a true friend, and one to whom tne younger members especi- 
ally, could go at any time for consultation and advice, with the assur- 
ance that it would be sound, good and disinterested. To his family 
we extend our warmest sympathy, but knpw that they are perfectly 
sure that the pure Christian life of Dr. Kirby made him entirely fitted 
for the sudden entrance in the next to which he was called. 

John W. Ward, 
Chas. R. Burroughs, 
: J. C. Felty, 





Dr. A. Van Nest Baldwin was bom in the city of New Brunswick; 
N. J., Nov. 16, 1858. He received his early education and college 
course in his native city, graduating from Rutgers College in 1879. 
In 1882 he graduated from the College of Physicians and Surgeons, 
New York City, and immediately became an intern of the Charity 
Hospital. After a service of eighteen months he began practice in 
New Brunswick, in partnership with his father. Dr. Henry R. Baldwin, 
and continued in that relation until his death, on Feb. 14, 1897, from 

By constant application and faithfulness to duty, Dr. Baldwin early 
acquired an enviable reputation among his professional brethren and 
the people of his native city. His outspoken manner and readiness to 
maintain his opinions brought him into notice, and he was appointed 
inspector for the board of health in 1888, and surgeon to the Penn<- 
sylvania Railroad in 1889, both of which positions he filled with ability 
up to the time of his last sickness. I'hree times he was elected a 
member of the board of education, which fact indicates in some 
degree the confidence placed in him. He always took an active 
interest in the Middlesex County Medical Society, serving many years 
as its reporter and several times as its representative to the State 
Medical Society, where his ability was recognized. 

On October 16, 1895, Dr. Baldwin was married to Mary Jane Bay- 
ard Kirkpatrick, who survives him. Dr. Baldwin's life was full of 
promise. He had already established his reputation as a careful, 
trustworthy physician and surgeon and it seemed that greater success 
was sure to come with advancing years. Whatever he undertook he 
did with a will, and when once he had determined his course of 
action nothing could turn him from what he thought his duty. He 
hated shams and trickery and labored to uphold the teachings of the 
golden rule. His early death is mourned by hosts .of friends, from 
whom, expressions of the deepest sympathy were extended to the 
honored father and the wife and child left behind. 

The following resolutions were unanimously adopted by the District 
Medical Society for the County of Middlesex, February 16, 1897, at a 
largely attended meeting^ held at the residence of Mayor William- 
son, M.D.: • : 


Whereas, In the death of Dr. A. Van Nest Baldwin, the District 
Medical Society for the County of Middlesex has lost one of its most 
active and promising members ; therefore 

Resolved, That the departure of our professional friend and brother, 
A. Van Nest Balidwin, M.D., fills us with the deepest sorrow. We 
gratefully recall his patient, ambitious and industrious spirit which 
secured nim thorough preparation for his professional life ; his courage 
in beginning practice in his own native city ; his fortitude and patience 
in the extreme illness which interrupted his career ; his positive con- 
victions, indomitable energy, ])ersistent application and careful study 
by which he overcame all obstacles, commanded respect, won confi- 
dence and secured for himself increasing success as a physician and 
surgeon ; his unflagging devotion to the care of the sick, both in his 
private and hospital practice, which in the end has sacrificed life in 
the effort to save. We record with highest praise his incessant toil in 
that highest sphere of the physician's activities, the prevention of 
disease and death, his faithful and successful service as inspector of 
this city's board of health, which places this entire city under lasting 
obligation to him ; his deep interest in this society which made him 
influential, not only in its councils, but also in the State Medical 
Society, where his ability was recognized. 

Resolved^ That his removal from so large and diversified a circle of 
medical influence in the midst of his years calls us to solemn reflec- 
tion on the uncertainty of life, the unstability of all earthly prosperity 
and the importance of positive, earnest, devoted character in us as 
physicians and citizens while time and opportunity are ours. 

Resolved, That we tender our sincere condolence and profoundest 
sympathy to the family of our deceased brother and to our greatly 
esteemed fellow-member. Dr. Henry R. Baldwin, and family, as we 
recognize with sorrow the loss of the father's son and partner in the 
midst of his own personal sickness. While we grieve with them 
that this life, in the fullness of its manhood, in its great serviceable- 
ness to mankind and with the great promise it gave of an enlarged 
sphere of activity, of influence and blessings to the community has 
been cut off, we also unite with them in grateful acknowledgment 
to God that during his illness our brother was permitted to receive 
such faithful ministries from those attending him ; that he was com- 
forted by the knowledge that he had the kindest wishes and prayers 
of the entire community, and especially that he was comforted and 
sustained by the Great Physician, to whose will he yielded himself in 
sweet and hopeful resignation and so, peacefully, passed from the 
busy earthly life to the higher sphere of heavenly service. 

Resolved, That we attend the funeral services in a body. 

Resolved, That these resolutions be entered on the minutes, that a 
copy thereof be sent to the widow and also to the father of our 
deceased brother, and also that they be published in our city papers. 


Dr. Compton was born at Liberty Corner, N. J., September 28, 
1855, and died April 5, 1897. Graduating at the College of Phy- 
sicians and Surgeons of New York, in March, 1 879, he began the 


practice of medicine in Bound Brook, and remained there till the 
-autumn of 189 1. He then removed to Blair, Nebraska, but returned 
to his native State about a year before his death. 



Dr. William Kelly Gray, of East Orange, N. J., was born in 
Patchoguc, L. I., in 1 82 1. He received his early education in the 
public schools of New York City, and graduated at*the University 
Medical College, in New York, in 1856. Soon after graduating, he 
■associated himself with Dr. Andrew Green, of Madison, N. J., where 
he built up a large and lucrative practice. In 1868 he moved to 
Summit, N. J., and connected himself with the Union County Medi- 
cal Society, in which he was an active and most interested member. 
His death was caused by apoplexy on July 7, 1896, while engaged in 
the active duties of his profession, to which he was ardently devoted. 



Dayton E. Decker was bom August i, 1856, at Metuchen, N. J. 
His parents were Dr. Dayton Decker and Martha Corwin, of Brook- 
lyn, N. Y. His preliminary education was common school and 
academic. His medical education was received at the Long Island 
Hospital College, from which he graduated in 1877, locating soon after 
in Woodbridge, Middlesex County. He was a man of quiet and 
unassuming ways, of sterling morality and thoroughly conscientious. 
His dealings with his fellow-practitioners were uniformly fair and 
just, and his kindly ways and blunt honesty will be long remembered. 
He was a hard and earnest student, exceedingly well versed in the 
theory and practice of modern medicine and an excellent diagnostician. 
While a resident of and practising in Middlesex County, he was a 
member of the Union County Society owing to better facilities 
for attending the meetings. His health began failing several years 
before his death,* and during the last few years of his life it was a 
-continual struggle to keep up. He was finally forced to give up in 
the spring of 1896 and went to Princeton to spend his last days with 
;his two sisters. He was never married. He died July 20, 1896, of 
4)hthisis pulmonalis. 


•  • 


To the Chairman of the Standing Committee^ &c,: 

The District Medical Society for the County of Atlan- 
tic, holds its meetings bi-monthly, except during the 
summer. Two members have been added to the roll of 
membership during the past year, as follows: Drs. Emery 
Marvel and William Edgar Darnall. At the March 
meeting the following were elected officers for the ensu- 
ing year : President, W. Blair Stewart ; Vice-President, 
A. D. Cuskaden ; Secretary and Treasurer, Walter 
Reynolds ; Reporter, William Edgar Darnall. 

Perhaps the most important event in the year's history 
of the Society was the formation of the Atlantic City 
Academy of Medicine. This was an outgrowth of the 
District Society, whose membership is made up very 
largely from the physicians of Atlantic City. While 
membership in the County Society will not be relin- 
quished by these physicians, it was thought that more 
frequent meetings, and at a different time in the day, 
would be more productive of scientific work and the pro- 
motion of fraternal relations. Heretofore, the only time 
suitable for the attendance of the country membership 
of the District Society was during the morning hours — 
a time when the city physicians were unable to attend. 
The consequence was that the meetings were not well 
attended. A new order of things has already taken 
place at the evening meetings which are held monthly, 
and members of the Academy have already felt mutually 



benefited by the more intimate professional and social 

During the year, papers have been read before the 
County Society by Dr. Boardman Reed and by Dr. W. 
B. Stewart, on " The Treatment of Inguinal Hernia ;'* 
by Dr. F. Savary Pierce, of Philadelphia, on "The 
Mental Influence in Disease," and by Dr. Wm. Edgar 
Darnall, on ** The Clinical Significance of the Discharges 
in Infantile Diarrhoeas." 

No deaths have occurred in the ranks of the profession. 

No epidemics have prevailed in this county as far as 
we could learn, except the usual outbreak of " la grippe " 
that afflicts most .localities in the early spring. Especial 
mention should be made, perhaps, of the vital statistics 
of Atlantic City, which is the most populous, as well as 
the most prominent point in the county. With a resi- 
dent population of 20,000, there have been ^o births, 27 
of these still-born. The number of deaths, including 
these 27 still-births, and 12 prematurely born, has been 
but 218, making the remarkably low death-rate 10.9 per 
thousand ; 25 per cent, of these deaths occurring among 
children of less than one year of age. If we exclude 
now the 27 still-births, 12 premature births, and the cases 
of violent death {t. e. accidents, etc., as in the meadow 
railroad disaster of last summer) numbering 56, the 
whole number of deaths is brought down to 123, or 6.1 
per thousand inhabitants. These figures do not, how- 
ever, include the 199 deaths occurring among visitors. 

These statistics, from the standpoint of the death-rate, 
easily places Atlantic City at the head of American 
health resorts, the nearest approach to these figures 
being Los Angeles, Cal., and Ashtabula, Ohio, each with 
a death-rate of 12 and a fraction per thousand inhab- 




To the Chairman of the Standing Committee^ &c,: 

The Reporter for Burlington County regrets that in 
sending your Committee an account of our proceedings 
for the past year he has no long list of interesting cases, 
no record of valuable scientific investigations — not even 
any important papers to report ; but he does not wish to 
have the conclusion drawn on this account that our 
District Society has settled down into a state of lifeless 

Our membership is as large as it ever has been ; all the 
meetings have been well attended and much interest has 
been shown in them, and although during the past year 
no formal papers have been prepared, there has been a 
large amount of informal discussion of the medical pro- 
gress of the day ; new remedies and new procedures, in 
which all have participated. The two subjects — appendi- 
.citis and antitoxin — seem to have been of perennial and 
undiminished interest, and a discussion of them has 
occurred with unfailing regularity. In the former, the 
sentiment of the society strongly favors obtaining early, 
the advise of a surgeon, and not allowing the case to 
slip away by adhering too long to medical means alone. 

The status of the antitoxin treatment of diphtheria 
seems well established, and its use has the cordial en- 
dorsement of all our members. Fortunately, our county 
has had very few cases of diphtheria during the past 
year, and but little need has been found for the remedy. 
I append a brief history of a case in which I employed 
it, in which the results seemed to me sufficiently aston- 
ishing to make it worthy of record. 

Baby, aged 5 months. Had been sick three days with 
what parents thought to be a **cold.** At my first visit 


I found tonsils, pharynx, nose and larynx a mass of diph- 
theritic membrane. In making the examination I acci- 
dentally abraded the upper lip. In a few hours the 
wound also was covered with membrane. Bacteriological 
examination confirmed the diagnosis. Laryngeal ob- 
struction was so severe that death seemed imminent at 
at any time. From the youth of the patient, the 
severity of the symptoms, and the length of time that 
had continued without treatment, I felt the case was 
almost hopeless. However, I immediately used i,ooo 
units of antitoxin. In about six hours the laryngeal 
stenosis began to improve and recovery was rapid and 
uneventful. I believe such a result in a five months old 
baby would have been impossible under any other 

Epidemics of the ordinary contagious diseases of 
childhood have occurred in every part of the county, 
but have mostly been of a mild type. The treatment of 
whooping-cough occupied a large part of the discussion 
at one of our meetings. Phenacetine, belladonna, fl. 
ext. of horsechestnut, and bromoform, were the favorite 
remedies, in the order mentioned. 

Our society has lost no members by death during the 




To the Chairman of the Standing Committee ^ &c.: 

In response to inquiries made to the members of 
the Camden District Medical Society, your Reporter con- 
cludes that the past year bas been a fairly healthy one. 


Disease in various forms has prevailed, very much as 
in former years, and death has been its attendant, 
but, on the whole, epidemic visitations have been less 
and the prevailing types have been mild. The most 
formidable epidemic was **la grippe," and this is but 
the repetition of the history of the past few years. 
While this disease was met with in the early autumn 
of 1896, sporadically, yet it was not until after the new 
year that it prevailed in epidemic form, attended with 
the various complications and sequelae that have made its 
periodical visitations so feared. During January and 
February, its presence was manifest in nearly every 
household ; during March and April there was a decided 
diminution in the number of cases seen, and, at the 
present writing, it is met with infrequently. 

The apparent tendency of this disease is to reappear 
earlier each year and continue later than the preceding 
epidemic. Typhoid fever has prevailed in various parts 
of the county, though not to a greater extent than here- 
tofore. Local epidemics of pertussis, parodititis, scarla- 
tina, rothlon, rubeola and diphtheria are reported from 
various sections of the county. Referring to prevailing 
diseases and treatment. Dr. H. Genet Taylor, of Camden, 
reports as follows : 

** The diseases met with in my practice during the past 
year have been generally of a mild type. " La grippe,** 
not so prevalent as in former years. Complications of 
tonsillitis and bronchitis accompany the disease in many 
cases. Pneumonia with pleurisy has been unusually 
prevalent. Gastro-intestinal catarrh has also prevailed to 
a large extent. While a large number of cases of typhoid 
fever have been treated, the percentage of deaths has 
been small in comparison with former years, and it is 
 to be hoped with our new supply of artesian water now 


to be introduced in the city, we may be able next year 
to reduce the number of cases to a minimum." 

Speaking of general treatment, Dr. E. L. B. Godfrey, 
of Camden, says : ** The utility of remedies possessing 
germicidal qualities, for purposes of internal disinfection, 
becomes more apparent each year. In the treatment of 
diphtheria and scarlet fever, bi-cloride of mercury stands 
preeminent. When administered internally and applied 
locally in germicidal doses in the treatment of diphtheria, 
I have had no occasion, during the year, to employ anti- 
toxin, except when the diphtheritic membrane invaded 
the nasal cavities or the larynx. This did not take place 
in any instance when the bi-chloride was early and 
thoroughly applied and administered. In cases when 
such an invasion occurred, antitoxin gave uniformly 
successful results. In scarlet fever, the employment of 
bi-chloride of mercury, with antiseptic care of the throat 
and the use of bi-chloride baths, has given entire satisfac- 
tion in every instance during the year." 

Dr. D. Benjamin, of Camden, reports that he continues 
to have uniformly successful results in diphtheria, on the 
line of treatment described and commented upon in 
extenso, in his paper published in last year's Transactions 
of the State Society. 

Dr. J. M. Ridge, of Camden, states that he has met 
with a few cases of typhoid fever during the year, all 
recovering. His diphtheria cases were all treated without 
antitoxin, and all recovered. The doctor reports many 
cases of phthisis. In this disease he depends upon cod 
liver oil, hypophosphites of sodium and calcium internally, 
with endermic applications of ichthyol, cod liver and aqua 
ammonia, with oil goultheria. For the night sweats, 
aromatic spirits of ammonia, atropia sulphate, strychnia 
and quinia. He reports a case of **la grippe" that termi- 


nated in a mild form of insanity, which recovered by the 
use of lactic acid and the alkaloid of strychnia. 

Dr. C. G. Hoell, of Camden, states that he has met 
with many cases of pertussis, occurring chiefly during the 
past two months. He also reports having treated a great 
many cases of throat and ear troubles — "more than I 
have seen for a great many years." 

Dr. Alexander McAlister, of Camden, says : ** I have 
had a larger number of ' la grippe * cases than usual the 
past winter, but only a few of these have been of a severe 
type. Pneumonia has complicated the disease, also otitis 
media and entero-colitis and (Complications have been 
exceedingly common." 

Dr. Paul M. Mecray, of Camden, states that he has 
made a number of Widal's tests for typhoid fever, and 
thinks it a very important aid in diagnosis. 

Dr. C. B. Donges, of Camden, has met with ocular 
sequelae of " la grippe." 

Dr. M. West, of Camden, states that typhoid fever, 
influenza, pneumonia and r5theln were the diseases 
chiefly met with during the past year in his experience. 

From Haddoniield, Dr. John R. Stevenson writes: 
*' There have been no epidemics in Haddonfield the past 
year. The health of the community has been better than 
usual. There has been some whooping-cough, measles 
and rotheln among the children, but not violent, and but 
little mortality. Of scarlet fever there were but three 
cases ; none fatal. Diphtheria, four cases ; typhoid fever, 
one case, without any deaths. * La grippe ' prevailed 
during the last of the winter and in the early spring 
months. Its type was not violent, but the after prostra- 
tion was marked. Children were sometimes attacked, a 
fact that has not been of frequent occurrence heretofore. 

''Although new attacks of malarial diseases have been 


infrequent for some years, yet some persons appear to 
have carried the germs in their system a long time, with 
occasional attacks of intermittent. In one case the six 
weeks infant of such a mother had an attack of the fever, 
which was relieved by quinine. In another the new-born 
infant of such a mother for two weeks was fretful and did 
not thrive, although apparently healthy. Its skin im- 
parted a feeling of chilliness, and was contracted. 
Quinine at once removed the symptoms and the child 
soon became vigorous." 

Dr. J. E. HurfT, of Blackwood, says: ** With the 
exception of * la grippe,' which has been very prevalent 
in this section during the last five months, there has 
been no epidemic of importance. I have noticed more 
pulmonary complications, especially catarrhal pneu- 
monia, during this epidemic, than ever before. Whoop- 
ing-cough has been endemic in different localities during 
the year, the worst cases being those complicated with 
* la grippe.' One case registered a temperature of io6^. 
I have had one case of more than usual interest : male, 
aged 37, was admitted to the Camden County Hospital, 
suffering with pyemia. About six years ago he had 
pleurisy, which became chronic. Two years ago he was 
tapped at the Cooper Hospital and relieved. Since that 
time he grew worse, and at the time of his admittance 
was in a very critical condition. I tapped the left 
pleural sack and drew off two gallons of pus. The lung 
was collapsed and infected with tuberculosis. He soon 
died. The special feature of the case was the enormous 
quantity of pus." 

Dr. John W. Marcy, of Merchantville, states that 
"la grippe" and rotheln have been prevalent in his practice 
all winter and up to the present time. 

Dr. H. H. Sherk, of Cramer Hill, reports thirty-five 


cases of diphtheria and membranous croup occurring in 
his locality during the past year. He also states that 
rotheln was epidemic, and typhoid fever, ** la grippe," 
rubeola and varicella prevailed. Pneumonia was very 
severe during the months of December, January, Febru- 
ary and March. Those cases following "la grippe" were 
unusually fatal. There has also been an unusual number 
of cases of rheumatism. 

Dr. O. W. Braymer, of Camden, gives a list of inter- 
esting operations, as follows: "Among several very 
interesting surgical cases, I will report a successful am- 
putation at middle third of thigh, in a man past 82 
years of age, for gangrene. 

"Also, resection of three inches of rib in a colored 
man who gives no history, but in whom there was an 
opening in the rib simulating a bullet wound, which I 
believe to be the fact. There was necrosis, and fluid in- 
jected in the sinus leading through the rib (5th, left side) 
was expectorated from the mouth. At the time of oper- 
ating I found a cavity extending into a bronchi ; also 
could explore the pericardium, etc. Also report three 
successful operations for appendicitis. A successful oper- 
ation for strangulated umbilical hernia in a woman five 
feet high, weighing 275 pounds. Removed a large mass 
of omentum. A case of supra-pubic cystotomy in a lad 
eighteen years of age, removing two calculi, each as large 
as a walnut. A case of brain tumor, of long standing, in 
which I trephined and removed the growth. A success- 
ful suturing of a recently fractured patella. Used 
kangaroo tendon for sutures." 

Dn D. Benjamin, of Camden, states that since his first 
case of ovariotomy he has had 21 consecutive cases of 
abdominal section, four pyo-salpinx, pelvic abscess, ovarian 


disease, fibroid tumor of uterus, etc., without a death and 
with remarkable good after-condition, cures being excel- 

Dr. William R. Powell, of Camden, gives the history of 
a case of glioma, in a boy eight years old', for the relief of 
which he removed the eyeball. 

Referring to sanitation. Dr. H. Genet Taylor, of Cam- 
den, says : ** The sanitary condition of Camden, I believe,, 
has been much improved during the past year, and the 
board of health has been vigilant in their efforts to abate 
all nuisances reported. The State Board of Health's in- 
structions to the local boards show the good results." 

Dr. Joseph H. Wills, of Camden, upon the same 
subject, expresses the opinion that " our city has made a 
decided advance in sanitation by the appointment of our 
new inspector. I think, however, we may be compelled 
to use still more stringent measures among the poor 
before we get them to aid us much in preventing the 
spread of contagious diseases.** 

Dr. H. H. Sherk, of Cramer Hill, says: ** A board of 
health has been organized in the town of Stockton during 
the last year, and many nuisances have been abated. 
Cooper Avenue, one of the main thoroughfares has been 
graded and macadamized its entire length, and other 
3treets are soon to be likewise treated. A system of 
sewers is soon to be built and efforts are being made 
for the disposal of garbage.** 

The annual report of the Board of Managers of the 
Cooper Hospital, just issued, states that 6i6 patients 
were treated in that institution during the year 1896. 
At the Camden City Dispensary a total of 10,138 were 
treated by the outdoor service. The seventh annual 
commencement of the New Jersey Training School for 
Nurses, of Camden, N. J., was held June 3, 1897, on 


which occasion sixteen graduates received the diploma of 

the school, conferring the degree of medical and surgical 

nurse. Dr. Orange W. Braymer delivered the address to 

the graduates. 

Dr. Thomas Garwood Rowand, at one time a member 

of this society, died in Camden, on January 25, 1897. 

His obituary notice has been contributed by Dr. E. 

L. B. Godfrey. 

Camden, N. J. 

Camden County Hospital. 


While the need of a separate building to be used for hospital pur- 
poses at the Camden County Almshouse had been felt for a number 
of years, it was not until the year 1880, just prior to the outbreak of 
that terrible epidemic of typhus fever, that such a building was 
erected. The hospital is desirably located on the corner just opposite 
the main building. It is a large brick building, containing two receiv- 
ing wards, drug room, basement, containing dining-room, kitchen, 
etc., and six wards, capable of holding from thirty to thirty-five beds. 

Within the last two years the building has not been sufficiently 
large to accommodate the sick, so last year an annex was built along- 
side the old one. It is a much larger building, and when completed, 
will contain a receiving room, operating room, elevator and twelve 
wards, capable of accommodating fifty-five patients, making a total 
accommodation for eighty-five or ninety patients. You can readily 
see the need of such a building when you remember that during the 
winter of 1880-81, prior to the outbreak of typhus, there were some- 
thing over two hundred inmates in the almshouse. 

The commitments to this institution have grown every year in pro- 
portion to the growth of the population of the county, and. especially 
of its three larger cities — Camden, Gloucester and Stockton. When 
you consider the great increase in vagrancy and pauperism in these 
cities, and the number of individuals who, having no homes, must be 
provided for by the county during the winter months, you can readily 


sec why there are so many at this institution. During the winter just 
past the number of inmates has been 269, the highest number at any 
one time. 

I regret that I am not able to give you a complete record of this 
institution since its erection in 1880. During the last two years there 
have been treated in the Hospital, according to the monthly reports, 
850 cases. This includes all those prescribed for, from the slight ail- 
ments up to the most protracted and fatal cases. Of the 850 cases 
treated, 1 58 were committed directly to the Hospital ; the remaining 
692 were inmates of the almshouse. Of the 158 cases admitted to 
the Hospital, 60 died, making a death-rate of 38 per cent. The total 
deaths for the past two years being 90; and estimating the total 
number of cases treated to be 700, making an allowance of 1 50 for 
cases reported more than once, as made by the monthly reports, 
would give us a mortality of nearly 13 per cent. Over 60 per cent, 
of the deaths that occurred were from those who were admitted 
directly to the Hospital wards. This is accounted for by the fact 
that most of the cases are old, bed-ridden, and in many instances, in 
a dying condition when brought in; and, in fact, in many cases 
simply brought in to die. 

There have been twelve women confined during the last two years. 
It would seem reasonable to suppose that in an institution of this 
kind, where it is almost impossible to have thorough asepsis, there 
would be some puerperal complications, but these cases have done 

The drug department is one of importance. There have been 
written during the last two years, 1,200 prescriptions; the renewals, 
etc., would number into the thousands. 

Since the year 1880, there have been in the institution cases of 
typhus fever, diphtheria, small-pox. scarlet fever, typhoid fever and 
membranous croup. Of the ninety deaths in the institution for the 
last two years, 18 died from consumption. 22 from heart dis- 
eases in different forms ; general debility and old age, 9; diarrhoeal, 
both acute and chronic, 5 ; pneumonia, 2 ; cerebral hemorrhage, 
I ; cerebral congestion, i ; septicaemia, i ; paralysis, i ; tubercular 
meningitis, 1 5 ; exhaustion from bed sores, 3 ; pulmonary hemorrhage, 
I ; congestion of lungs, i ; delirium tremens, i ; albuminuria, i ; 
gangrene, i ; chronic peritonitis, i ; cirrhosis of liver, 3 ; acute syphilis, 
I ; inflammation of bowels, i. 


The death-rate for the foundlings brought into the hospital has 
been heavy, owing to the fact that most all of these children have been 
neglected and exposed before they were deserted by their mothers. 
In the majority of cases they are starved, emaciated and suffering, 
to a greater or less extent, with some bowel complications. These 
little ones, after being cleansed, are handed over to some one of the 
female inmates to be cared for. At the most they are unwelcome 
charges. During the two years eight of these little ones have died 
from entero-colitis, five from cholera infantum and one from convul- 

There have been three cases of typhoid fever and two cases of 
diphtheria in the last two years. The surgical work done in the 
institution while not great, is of some interest. The most important of 
operations was an amputation of an arm for gangrene. The lesser 
cases consist of amputation of toes for frost bite, one case of castra- 
tion for tubercular testicle. Fistula in ano is quite common. The 
operation for strangulated hernia has been done but once. The 
patient was a colored man, age sixty, having a very pronounced 
valvelesion of heart. My colleague, Dr. Branin, assisted me by giv- 
ing ether. The patient became almost pulseless while etherized and 
looked as though he would die, but rallied. The work was com- 
pleted. He came out from the anaesthetic fairly well, but about 4 a. m. 
the next morning he was taken with heart failure and died ; no one 
being with him to watch the flagging pulse, to stimulate or to render 
any assistance, no efficient nurse — having but the other inmates to 
wait on him. Thus, what ought to have been a most successful case, 
died. ' 

There have been two cases of serious gun-shot wounds treated. 
The first case, a young man from Gloucester City, while on the street 
was shot by a bartender. The man threw up his elbow, as though to 
protect his face. The ball, one of large size, struck him in the left 
arm just above the elbow and emerged just below the middle of left 
clavicle. The arm was in a terrible condition when he was brought 
in but he made a good recovery. 

The second case was a young mAn from Philadelphia, boarding close 
by. While with some companions fooling with a shot gun, he was 
accidentally shot in the left leg. The full charge of bird shot struck 
him in the calf of leg, posteriorly to the bones, blowing away nearly all 
the calf, the length of the tear being about four inches. Fortunately 


the bones were not shattered. The wound was a terrible one, the 
edges being ground up like pulp. The posterior tibial artery and 
nerves were involved. The bleeding vessels were ligated, the debris 
all removed from the wound, which was then dressed antiseptically. 
The young man was in the hospital wards about eight days. During 
that time his condition was most favorable. He was then removed by 
his father to one of the Philadelphia hospitals where he made an un- 
eventful recovery. There are many other cases of minor importance. 
The general work to be done in this institution is anything but 
pleasant. The sick have to nurse one another. Generally there is 
some one in the wards slightly sick or disabled in some manner, who 
can be placed in charge and who will look after the rest. During the 
last two years, in many ways, this institution has been made to 
resemble more and more, a regular hospital. Instruments and other 
useful articles are being added from time to time and I hope in the 
near future to be supplied with all the appliances necessary for the 
work to be done. Much more could be said about this institution by 
going into the general work and management, but I think this brief 
statement covers the most important points of interest in its work. 


To the Chairman of the Standing Committee y &c,: 

While the numerical growth of Cumberland County 
Medical Society has not been very great, it has been 
proportionally good and has been progressive from the 
time of her birth, Dec. 8, 1818. During the last five 
years however, new life seems to have come to the 
society, unusual interest having been manifested by the 
members. The interest has been increased by the 
election to associate membership of Drs. Chas. O. Oliver, 
W. E. Ashton, W. W. Keen, P. D. Keyser, J. M. Barton, 
B. C. Herst and Theoph. Parvin, of Philadelphia. 

Instead of the annual and semi-annual meetings only, 
as was the custom for more than half a century, we now 


have two special meetings, making them quarterly. Dur- 
ing the year three candidates have been elected to active 
membership and one member reinstated. Important 
changes in the constitution and by-laws have been 
recommended by an efficient committee and adopted by 
the society, so that they now are consistent with, and 
correspond very closely to those governing the State 
Society. The attendance at all of the meetings has been 
very good and the essays carefully prepared. The 
principal essays written upon and discussed have been : 
""Professional Unity,** by Ellsmore Stites, M.D.; "The 
Financial or Business R61e of the Physician," by S. M. 
Snyder, M.D.; " Hydrophobia," by S. M. Wilson, M.D.; 
" Penetrating Wounds of the Abdomen,** by A. Corn- 
well, M.D.; " Dysentery,'* by A. W. Sullivan, M.D.; ** Eye 
Strains,** by O. H. Adams, M.D, ; ** Indigestion," by 
L. L. Hand, M.D.; ** Conjuctivitis,** by G. E. Day, M.D. 

Interesting and instructive papers on advances in 
the various branches of medicine and surgery have been 
given. We regret that we are unable to give abstracts 
from these, also from the excellent essays, which is due 
to the fact, that your reporter, although he heartily 
•endorses this plan, was not aware of the proposed change 
in the method of reporting until too late to obtain them. 
No epidemics of any moment have occurred in the county 
during the year, the contagious diseases having been of 
a mild type as a rule and few in number. The number 
of typhoid fever cases has been somewhat larger than 
that of last year but with lower death-rate. We shall 
undoubtedly be visited, from time to time, by this dis- 
ease, until the use of wells and the cesspool drainage in our 
cities are wholly abolished and a more perfect drainage 
system adopted. 

Our society has lost by death, during the year, one of 


its most respected and formerly most active members, 
Dr. Charles R. Wiley, who practiced his profession 
successfully in Vineland for many years. The obituary 
notice will appear elsewhere. The Cumberland County 
Medical Society has always been and still is, in close 
relationship with the State Society. Of the list of 
" Fellows," Cumberland has had her proportion, and with 
the retirement of the presiding officer, for the current 
year, another will be added to the list. The State 
Society has also favored us in giving us a member of the 
Standing Committee for ten of the last eleven successive 
years, thus continually keeping our society in close touch 

with the parent society. 

J. C. APPLEGATE, Reporter, 
Bridgeton, N. J. 


To the Chairman of the Standing Committee^ &c.: 

The society is in a very flourishing condition and a 
great deal of interest is taken in it by the members. 
There is always a good attendance at the meetings. 
Epidemics of typhoid and intermittent fever, diphtheria, 
measles, rotheln, whooping-cough and scarlet fever have 
been reported during the year. Antitoxin is used very 
frequently in diphtheria and with good results in almost 
every case. One case is reported by Dr. Nelson, of 
Woodbury, in which it was used, where he thought the 
cause of the disease was not aflfected by it, but in all the 
other cases where he has used it, marked action for good 
has been noticed, as has been the result in all other cases 
reported to the society. 

In a number of cases of roseola, a decided tendency 
to follicular tonsilitis was noticed. At the November 


meeting, Dr. L. M. Halsey, of Williamstown, read an 
essay, entitled " Bilious Headache/* which was very 
instructive and showed considerable thought and research. 
After the reading, a general discussion by the members, 
upon the subject, took place. A general discussion upon 
the use of ergot during labor, occurred during the March 
meeting, which was of much practical value and brought 
out a great diversity of opinion in regard to its use at 
this time. Some gave ergot in almost every case of labor, 
and some never, while each seemed to feel as if they 
obtained the best results from so doing. 

Dr. Stout, of Wenonah, reported a case of paroxysmal 
pain, beginning in the elbow. The patient presented 
enlargement in the hepatic region. A consultation was 
held, and cancer of liver was suspected. An exploratory 
incision was made. No cancer was found, but a very 
much enlarged gall bladder, filled with large calculi, 
which gave it a nodelar appearance before being opened. 
The calculi was removed and the patient did well for a 
few days, when death took place from hemorrhage, from 
a rupture of the aorta, caused by pressure of a large 
calculi. Dr. Diverty, of Woodbury, reports a case of 
abscess of the liver, which ruptured into the stomach, 
the patient vomiting a large quantity of pus, etc., amount- 
ing to about nine quarts. 

Dr. Reading, of Woodbury, reported a case of albu- 
minuria, in an old man, with general dropsy. He was 
treated with digitalis and large doses of sugar of milk, 
with prompt temporary recovery. He had found, also, 
in other cases, that sugar of milk given in large doses, 
decreased the albumen and increased the urinary flow. 
He also reported the particulars of two cases of laparot- 
omy, occurring in his practice ; one for pelvic adhesions, 
following tubular pregnancy with rupture, and the other 



a case of appendicitis, with abscess, from which four 
ounces of pus were evacuated. Both patients made 
good recoveries. Dr. Oliphant, of Bridgeport, reports a 
case of miscarriage, attributed to the use of turpentine. 
One month afterward the patient was taken with complete 
aphonia, which has persisted, with very little improve- 
ment from treatment. 

Dr. Hunter, of Westville, reported a case in which he 
was called for supposed constipation. He gave a brisk 
purge. The next day the patient was in bed, com- 
plaining of no pain but merely lassitude. An examina- 
tion of the urine showed it solid with albumen. The 
patient died the same afternoon. The case is peculiar in 
that there had been no oedema or other symptoms of 
kidney disease. Dr. Hunter also reported two cases of 
sudden death from fatty degeneration of the heart, and 
exhibited the post-mortem specimens, showing small 
multiple ruptures in auricle of one. He also exhibited 
specimens of contracted kidney obtained from a case 
occurring in his practice, showing the diseased condition 
very plainly. 

Dr. Halsey, of Williamstown, presented a case before 
the society, of a man aged forty-five years, who had 
suffered for thirty years from asthma, until six years ago, 
when he noticed his fingers grew cold while the rest of 
his body was warm. Two years ago his feet and hands 
swelled and the joints became stiff, seemingly due to a 
stiffness of the skin and the tissues about the joints. 
The examination of the urine was negative, circulation in 
the extremities was very poor. Since these symptoms 
have developed, the asthma has disappeared. The case 
was examined by the members of the society present, 
and was considered a rare case. 




To the Chairman of the Standing Committee^ &c.: 

It IS gratifying to be able to report a decided improve- 
ment in the hygienic conditions of the county since I 
last had the honor of addressing you. The death-rate 
for the year is 22.7, whereas in 1895 it was 25.7, which is 
a remarkable showing when we consider that there are 
in our borders twenty public institutions, including the 
Soldiers* Home, at Kearny, that many railroad trains and 
trolley cars pass through the territory at a high rate of 
speed, and that the pestilential manure and abattoir 
industries still thrive and convey their noxious odors far 
and wide, offending the sensibilities of our citizens and 
travelers through the county. Attempts to remove these 
menaces to health have been made in past years, without 
success or even material progress toward accomplishing 
the desired result, but I believe I am warranted in prom- 
ising that an energetic and carefully considered move- 
ment will soon be inaugurated which; let us hope, may 
be successful. 

The introduction of Pequannock water throughout the 
county during the year has doubtless had much to do 
with the improvement in our hygienic condition. Since 
then no cases of typhoid fever have been reported and 
but few of any other disease of a malignant nature. If 
the people and their representatives in official life could 
be made to understand the necessity of improving the 
sanitary condition of the communities, and would apply 
the appropriate remedy, i would not be long before 
Hudson County would, from a hygienic point of view, 
assume a prominent rank among the counties of the 

The number of deaths during the year is 6,403 ; births, 


6,1 16. The population, according to the census of 1895, 
is 338,671 ; an increase of about 57,coo. 

My requests, sent to members of the profession, that 
they send to me reports of noteworthy cases coming to 
their notice, have not met with the hearty response that 
could be desired. I fully appreciate the fact that the 
exacting demands of our profession leave little time or 
inclination for such work. I would respectfully suggest, 
however, that although the task of reporting such cases is 
gratuitous, and to the careless observer may seem thank- 
less, yet one of the chief aims of our profession, that of 
relieving distressed humanity, is as well subserved by the 
dissemination of knowledge of the progress and improve- 
ment in the science, as by direct attendance upon the 
individual cases. The enclosed report of an interesting 
case occurring in the practice of Dr. C. F. Kyte, is worthy 
of any one's perusal. 

I am yours, with great respect, 

J. A. EXTON, Reporter. 

Cases of Asphyxia. 


On Saturday, April 24, 1897, at 12 o'clock noon, I was called to see 
Mr. and Mrs. R. They had retired at 9 p. ni., Friday. They are 70 
and 72 years of age and live alone in a two-story and basement frame 
cottage. Not seeing them about as usual Saturday, a. m., the 
neighbors investigated, and detecting the ordor of illuminating gas, 
broke in the house. The young woman who opened a rear window 
was overcome by the gas. Her brother succeeded in entering and 
opened doors and windows, and was sick the rest of the day as the 
result of the exposure. 

Mr. and Mrs. R. were on the top floor in rear bedroom. The 
leak of gas was in the front basement dining-room, from a fixture 
suspended from the ceiling, which had probably been disturbed by 


paper hangers working there during the day. As Mr. R. closed all 
outside doors and windows before retiring, the house filled with gas 
during the fifteen hours elapsing from the time they retired till they 
were found, and the wonder is that at the end of so long an exposure 
there was any life left. When found they were nearly naked, 
evidently having attemped to arise and fallen back on the bed. They 
had both vomited and were lying in their own dejections. 

Mr. R., a short, medium, plethoric man was more profoundly 
poisoned of the two ; his face was swollen and livid ; the conjunctivae 
were so oedematous as to protrude from his eyelids. His pulse was 
very slow and feeble, his respirations six per minute, shallow and 
every indication existed that life would cease in a few moments. 

Mrs. R., a tall, thin, very delicate, nervous woman, with chronic 
catarrhal bronchitis, incipient paralysis agitans and an acute attack 
of *'la grippe," was not at all swollen but presented a death- 
like palor. Her respirations could with difficulty be detected, and her 
pulse had nearly ceased. The treatment consisted in promptly 
placing each one at an open window, performing artificial respiration, 
and stimulating with strong doses of carbonate of ammonia and 
whiskey, followed by hot coffee. These fluids were forced into their 
mouths, and though unconscious, they swallowed when the angle 
of the jaw was lifted. 

Mrs. R. became semi-conscious during the night and fully conscious 
during the afternoon of Sunday. She was extremely weak and 
troubled with a severe cough,, due to her old bronchial conditions, 
aggravated by " grippe " and gas. These troubles improved under 
proper treatment and she now is as well as ever, except that what she 
calls her *' nervousness " (paralysis agitans) is increased. 

Mr. R. for three days remained semi-delirious and part of the time 
inclined to be violent. It was necessary to catheterize him and 
empty the bowels by enema. Urine and dejection were strong with 
ordor of gas as late as the third day, when he was able to urinate. 
His hearing, normal before the accident, was so impaired that he 
could not understand any effort to make him hear, but when on the 
third day a question was written, he read it with some considerable 
difficulty and answered it with the comment, *' Well, I am not a fool 
yet, I can read that." In his delirium he imagined that he had been 
arrested and clubbed, and his violent attempts were to get away from 
his keeper (a nephew of his wife's who was very kind to him, but 


who had to give the medicine, which, to Mr. R., was a persecution), 
though he recognized and addressed me. _ 

On Tuesday, p. m., I wrote him that his wife was all right, would he 
like to see her. He answered yes, and we brought her in from next 
room and set her by his bed-side. He took her by the hand, looked 
in her face for a minute or two and then slowly said, " Well, Jennie, I 
guess we fell into the hands of the Philistines." In the past six weeks 
his hearing has almost entirely returned. His memory, which was 
formerly excellent, is now poor and his greatest difficulty is from 
vertigo, on account of which he has had one bad fall. 


To the Chairman of the Standing Committee^ &c.: 

This District Society holds two meetings each year, 
one in April, the other in October. These meetings are 
well attended. Besides the reading of essays, reports of 
rare and interesting cases are submitted. These are usu- 
ally followed by a discussion in which nearly all the 
members participate. 

At the last meeting, Dr. E. W. Closson read a paper, 
in which he gave an account of his experience with anti- 
toxin in the treatment of diphtheria. Dr. George L. 
Romine made a preliminary report of an epidemic o( 
typhoid fever which had attacked a number of the 
employes of one of the rubber mills in Lambertville, 
and which was attended by a high death-rate. Dr. 
Romine also gave a resume of five cases of laryngeal 
diphtheria treated by antitoxin and intubation. These 
reports were followed by an animated discussion and a 
free interchange of opinions as regards causation and 
treatment of the diseases under consideration. 

Usually, once a year, a specialist from Philadelphia or 
New York addresses the society. These addresses are 
decidedly beneficial in that they not only present the 


latest views as regards causation and treatment of 
diseases, but bring us also in direct contact with some of 
the leading men in the profession. 

During the past year there have been no notable epi- 
demics or endemics except the one to which reference 
. has already been made. Many deaths, however, occurred 
during the winter and spring, mostly of the older inhabit- 
ants. " La grippe " has been, directly or indirectly, the 
exciting cause in many of these. In fact, nearly all 
forms of acute disease were ushered in by more or less 
marked grippal symptoms and their usual manifestations 
peculiarly modified by them. 

It becomes my painful duty ro report the death of one 

of our most useful members, Dr. William R. Little, of 

Bloomsbury, a man eminently successful in the practice 

of his profession and highly esteemed by the community 

in which he lived. 

G. N. BEST, Reporter. 


To the Chairman of the Standing Committee^ &c,: 

Contagious Diseases, — From May i, 1896, to April 30, 
1897, the following number of cases of contagious diseases 
were reported at the office of Trenton Board of Health : 
Of diphtheria, there were 222 cases, with 44 deaths. In 
130 of these cases antitoxin was used, with 14 deaths, a 
mortality of 10.76^. Of the cases thus treated, four 
were almost moribund, no one of them living longer than 
ten hours. If these be excluded the mortality rate falls 
to 7.6^. Ninety-two cases were treated by ordinary 
methods, of whom 30 died; giving a mortality of 32.6^. 

Fifty-six cases of scarlet fever were reported, with only 
one death. Mortality rate, 1.78^. 


One hundred cases of typhoid fever occurred, of which 
i6 died, showing a mortality rate of i6jg. 

Whooping-cough prevailed to an alarming extent dur- 
ing the summer and fall of 1896. 

Work of the Society, — The society has had a fairly 
prosperous year. The papers read during the year were 
as follows: Dr. Weeks, " Observations on some Foreign 
Hospitals ;" Dr. Sommer, ** Fever in its General Aspect ;** 
Dr. Adams, *' Typhoid Fever;*' Dr. Costill, ** Typhoid 
Fever ;" Dr. I. M. Shepard, " Hydrophobia ;** Dr. J. 
Bruyere, ** Tetanus ;" Dr. J. Bruyere, ** Sketch of the 
Society from Cases Reported : Its Foundation ;" Dr. 
Cantwell, " Case of Tubercular Kidney treated by Neph- 
rectomy, with good result.** 

Dr. Burroughs reported a case of cancer of the stomach, 
in a man aged 58, a painter, and inebriate. Had dys- 
pepsia, pain, emaciation, no vomiting. Autopsy showed 
pyloric tumor, considerable narrowing of that orifice and 
much ulceration. 

Dr. Struble : A case of cancer of the upper jaw, 
treated with injections of protonuclein, by some quack, 
with result of abscesses and death. 

Dr. Costill : Three cases of phthisis, treated with 
aseptolin-Edson. No benefit. 

Dr. Mackenzie: One of phlebitis, in which eighteen 
inches of the vein was excized, with good result. 

Sanitary Improvements. — In Trenton the sewer system 
has been considerably extended. A filtration plant for 
the city of Trenton is being agitated by the board of 
trade and the medical society. The matter is under con- 
sideration by the water board. 

Deaths. — Dr. John Kirby, at the State Hospital for 
Insane, Trenton, of apoplexy. 

GEORGE N. J. SOMMER, Reporter. 
Trenton, N. J. 


To the Chairman of the Standing Committee^ &c,: 

My report, if limited to the important transactions 
of the Middlesex County Medical Society, must neces- 
sarily be brief. It seemed impossible to get the members 
of the society together until aroused by the death of our 
fellow-member, Dr. A. Van Nest Baldwin, which occurred 
on February 14, 1897, from pneumonia. At a largely 
attended meeting, held to take action in regard to his 
death, resolutions were adopted, which will be found 
elsewhere, and the sentiment of the society seemed to 
be that we should take up more actively the work appro- 
priated to the society and try to derive benefit from the 
meetings of the association. Our meeting in April was 
well attended, and considerable business in the way of a 
reorganization was transacted. One new member was 
elected and one old member returned to us after several 
years practice in the West. More interest was shown 
than at former meetings. 

The health of the county has been unusually good, 
with the exception of a short period when ** grip *' was 
prevalent, and a somewhat longer time in the winter 
when pertussis was rife among the children. Both of 
these diseases were frequently complicated by pulmonary 
troubles. Diphtheria and scarlet fever have prevailed to 
some extent during the year. Our physicians are looking 
with more favor upon antitoxin than formerly. 

A. L. SMITH, Reporter. 
New Brunswick, N. J. 


To the Chairman of the Standing Committee^ &c,: 

Your committee received the history of this medical 
society so fully about ten years ago that it seems quite 


proper to omit that feature in this report. Our present 
membership is thirty-six, two of whom were received at 
our last meeting, and one withdrew from our society at 
the same time. Meetings are held twice annually, in 
May and October respectively. The spring meeting is- 
always in Freehold, at one of the three commodious- 
hotels, all in turn having entertained our society to the 
full satisfaction of all. About two-thirds of our mem- 
bers are present at this meeting. At this time the 
officers of the society are elected for the ensuing year,, 
and new members received. The October meeting is to 
be held at Allaire this year. There being no fixed place 
for this meeting, each year a new place is chosen by the- 
society, and thus are offered reciprocal benefits in point 
of committee entertainment and the expense and time 
of traveling. 

The order of business of this medical society is, briefly t 
Call to order at 1 1 a. m.; roll call ; application and exam- 
ination of candidates for membership ; balloting for new^ 
members ; reports of committees, etc.; adjournment for 
a banquet from i to 2 p. m. At the after-dinner session 
the President delivers his address, and sometimes one or 
more papers are read on a subject chosen by the writer,, 
and then each member is called, alphabetically, to report 
anything of special interest gained or experienced since 
making such a report. As for example, at the meeting 
last month. Dr. Field, of Red Bank, Dr. Hughs, of Long 
Branch, and Dr. Long, of Freehold, spoke of their per- 
sonal experience with antitoxin diphtheritica. After citing 
several cases in which it had been used, their opinion 
expressed was that no ill results had been observed in 
its use ; that several lives were thought to have been 
saved by it ; its early use with a reliable preparation was 
advised ; as a prophylactic its results appeared certain^ 


and to be indicated among those exposed to the con- 
tagion of diphtheria. 

Dr. Forman, of Freehold, exhibited two calculi of 
unusual size which he removed from the bladder of a 
male, aged 72 years, the patient making a good recovery. 
He also reported his use of Schleich*s method of local 
anaesthesia by infiltration, using two ounces in an opera- 
tion in the removal of a small benign tumor. The large 
quantity of the cocaine solution injected into the tissues, 
rather than itis strength, seemed the cause of the success- 
ful results. 

Dr. Crater gave a recent singular experience with twin 
birth, in which one infant, born in full health, weighed 
eight pounds, while the other was a dead foetus about 
the fifth month of pregnancy, corresponding with the 
date of a threatened abortion following a severe fright of 
the mother. 

Of the newer remedies thus mentioned, Dr. Knect 
spoke of urotsopine as a very powerful diuretic, especially 
useful in chronic Bright's disease. 

From the above you can perceive the character and 
general work of this society. 

Very respectfully submitted, 




To the Ckairmafi of the Standing Committee ^ &c.: 

In accordance with the request of the Chairman of the 
Standing Committee, that the report this year consist 
chiefly of an account of the proceedings, etc., of the 
several district societies, the writer takes pleasure in 
recording the fact that the Morris County District 


Society, which he has the honor to represent, was never 
in a more prosperous condition than at present. The 
society has upon its roll a membership of forty-five, with 
a prospect of further increase. 

The meetings are held twice yearly, on the second 
Tuesdays of May and December. They are, as a rule, 
well attended and great interest shown therein. The 
December meeting is generally devoted almost entirely 
to scientific work, at which time two papers, prepared by 
previous appointment, are read and thoroughly dis- 
cussed. Verbal reports of interesting and unusual cases 
are also received and discussed. The annual meeting in 
May is necessarily somewhat more of a business charac- 
ter, but one scientific paper, as a rule, being presented. 
At this meeting the officers for the ensuing year are 
elected, together with the delegates to the State Society, 
American Medical Association, etc. 

At the meeting of the society, held in Dover, Dec. 8, 
1896, Dr. P. A. Harris, of Paterson, a former member of 
our society, was its honored guest, and by invitation, read 
a paper on "Septic Infection of the Female Pelvic 
Organs." The paper was thoroughly enjoyed and the 
doctor received a hearty vote of thanks for the same, to 
which he happily responded, expressing his pleasure at 
meeting his former medical associates. Dr. Thos. P. 
Prout, of the State Hospital at Morris Plains, also read 
a most excellent paper on "The Diagnostic Value of 
Blood Examination." The paper was illustrated by 
charts and drawings explanatory of the blood appearance 
in health and disease. Some microscopic specimens 
of morbid blood changes were also exhibited. Dr. H. V. 
Day, of Bloomingdale, read a very practical and 
thoroughly enjoyable paper on " Catarrhal Pneumonia," 
which was quite generally discussed. 


At the annual meeting held in Dover, May 11, 1897, 
Dr. C. N. Miller, of Flanders, read a paper on ** Septic 
Puerperal Disease/' which was received with great 
interest and elicited an interesting discussion. Dr. Levi 
Farrow, of Middle Valley, gave a descriptive history of 
a case of obscure abdominal trouble, a full account of 

which accompanies this report. 

E. P. COOPER, Repofter, 

Canxer of Rectum; A Unique Case with 

Obscure Symptoms. 


Miss F., aged about fifty years ; school teacher; nervous tempera- 
ment ; formerly somewhat of an invalid, but latterly in good health ; 
without previous indisposition ; was taken ill December i , 1 896, with 
slight nausea and pain in the epigastric region ; no particular tender- 
ness or indurations at this point nor any other part of the abdomen. 
Pulse normal, temp. 99° ; judged trouble was of catarrhal nature, as 
many people were complaining about the same way and were quite 
readily relieved by ordinary treatment, which, however, proved 
totally unavailing in this case. No urgent symptoms of any character 
existed, except an inability to move the bowels, after thorough trial 
of usual cathartics and enemata, calomel, small and large doses, 
rochelle salts, castor oil (more than a quart), etc., including injections 
through a rectal tube introduced 21 inches. The tube {-^ in 
diameter) passed quite easily without pain, by injecting the fiuid as 
introduced. Neither fiuid, feces or flatus passed the rectum. On sixth 
day, I deemed it a case for a surgeon and called Dr. I. W. Condict, 
of Dover, N. J., who approved treatment, and advised, in the absence 
of urgent symptoms, as collapse, pain, tumor, vomiting, except 
evident obstruction and considerable general tympanitus, and as the 
patient had a good pulse, scarcely any fever and relished and 
retained a fair amount of nourishment, to treat the case on the 
expectant plan a short time and await developments. On Dec. 9, 
called Drs. Condict. P. A. Harris, of Paterson Hospital and J. R. 
Farrow, with intention of opening abdomen. 


After a careful examination, no positive diagnosis could be made, 
and the general condition of the patient did not seem to warrant 
extreme measures. It was decided to take the patient to Paterson 
Hospital, for more careful observation and an operation, if imperative. 
She made the journey of seven miles in a wagon to the depot and 
thence by railroad quite comfortably and the following extracts from 
letters of Dr. Harris continue the history and treatment of the case. 
The rectal tube failed to pass on the evening of the 8th, but flatus 
passed the bowels for the first time, a short time previous to starting 
for the hospital. 

Reports by Dr. Harris : *' Dec. 9. 1 1 p. m. — Just left patient ; has 
passed a good deal more gas ; feeling rather better ; no fecal matter. 
Will not operate until I see if matters will not move. Treatment : 
i gr. cal. every half hour ; massage abdomen ; high hot water enemas, 
containing an ounce sulphate magnesia. She made the journey 
very easily. 

"Dec. 10, 10 p. m.— Miss F. is no worse, passing flatus, and we 
have hope of avoiding operation. 

" Dec ! I — As yet, no especially alarming symptoms ; no morphia 
has been given, except a small dose first night. Expect to have 
consultation tomorrow and may then decide upon an abdominal 
section ; no vomiting and not much pain. 

"Dec. 12 — Had staff consultation this a. m. and decided that 
although there had yet been no evacuatiop, that it was not 
advisable to operate. The argument against operation was princi- 
pally, that her condition ought to appear more serious. Temp. 
99® ; treatment : enema, peptonized milk and beef tea ; patient quite 
cheerful and comfortable. 

"Dec. 13, 9 p. m. — Upon a staff consultation, it was decided to 
operate, which I did at 1.15 this afternoon. The condition found was 
a tumor of the upper portion of the rectum, just immediately below the 
flexure of the sigmoid. This growth constricted the gut to the size of 
say I to t of an inch. Above the growth the intestine contained many 
quarts of fecal matter. Opened colon and flushed with salt water, 
getting clear of both feces and gas. The tumor was then cut out 
and the ends connected with Murphy's button. Patient waked badly ; 
pulse 1 58. I remained with her until six o'clock. Reacted very well 
and has had three small natural movements. 

"Dec. 15 — Patient showed every sign of doing well until midnight. 


'when pulse g^ew weak and irregular. She lived until about six 
o'clock this morning. Not two ounces of blood were lost at operation. 
Even to time of operation there was no fecal vomiting and very little 
nausea, and distension of abdomen was rather decreasing. There 
were no ordinary symptoms of strangulation present. The tumor 
'was circular, about an inch in diameter, and pronounced cancerous by 
Dr. T. P. Prout, of Morris Plains Hospital, after microscopical 

The interesting features of this case, are first, its comparative rarity ; 
rsecond, high location for a cancerous growth in the rectum ; third, no 
local symptoms whatever, preceding or attending, referable to the 
•disease or location, all pointing to epigastric region ; fourth, such 
rslight constitutional disturbance for so grave a disorder ; fifth, rapid 
progress of the mechanical obstruction without referring one dis- 
tinctive symptom to the point of occlusion. Queries — How long had 
this cancerous growth existed ? Was it acute, and a cause of the 
attending symptoms and consequent occlusion, or only an incident of 
the supposed catarrhal condition, and a slumbering cancer hastened 
in its malignant development by favorable accidental conditions ? 

All the principal symptoms were referable to the epigastric region ; 
the bloating began there and gradually spread over the abdomen, but 
^was always most prominent at that point. The abdominal section 
-was made, expecting to find the trouble there, only to be disappointed, 
and to go on an extended voyage of discovery, until finally it was 
located in the upper rectum. The sequel seems to prove that an 
-early diagnosis and operation and Murphy's button might have pro- 
longed life, barring the malignancy and uncertainty of cancerous 
growths generally. Finally, what more could have been done under 
the circumstances ? The cancer gave no pain, even when distended 
by the rectal tube up to the seventh day, and not even then to any 
:great extent. Deep pressure in that region failed to detect the small 
tumor or any distress, and its growth to fatality was as cloaked as it 
5vas persistent and pernicious. 



To the Chairman of the Standing Committee ^ &c.: 

Salem County physicians have been exceedingly busy 
during this past winter, treating "la grippe" and its 
many sequelae. Pneumonia and typhoid fever were 
quite prevalent at various places. Woodstown and 
Quinton probably had more than their share of typhoid, 
thought to be caused by low water in the wells. The 
pneumonia was mostly infectious, several in a family 
having it together or one after the other. 

In a number of the typhoid cases, the symptoms of this 
disease in the beginning were absent or greatly masked 
by the concomitants of ** la grippe.'* French measles 
and whooping-cough have both been prevailing in the vari- 
ous townships. Numerically and financially our society is 
very weak, but socially very strong, judging by the time 
consumed in argument and at the table after adjourn- 
ment. Some new members have joined and more 
interest is manifested now than there has been, indicating 
a bright future. We have had pleasant visits from 
delegates from neighboring medical societies, especially 
Gloucester and Camden. We have been honored and 
enlightened by their presence, and also by speeches by 
some of the professors and teachers of the Medico- 
Chirurgical and Jefferson Medical Colleges, of Phila- 
delphia. It was suggested at our last meeting, by the 
visiting members of Gloucester County, and adopted, 
that our society appoint a visiting delegation to meet 
with the Gloucester Society and they in turn with us, 
in order that our social relations and medical knowl- 
edge might be extended. 

In concluding this report, I would recommend as the 
most important thing they can do, that our members and 


Other physicians should meet and devise a plan for collect- 
ing our hard-earned fees from that class of people who will 
not pay, even when they have plenty of money for all 
other necessary and unnecessary pleasures of this life. 
That such a state of affairs exists and is growing worse 
cannot be doubted, and should not be longer tolerated 
without protesting, 

Fraternally yours, 

WARREN L. EWEN. Reporter. 
Allow AY, N. J. 


To the Chairman of the Standing Committee^ &c,: 

Continued interest has been manifest in the meetings 
of our society. The attendance has been good, with the 
exception of our January meeting, when no quorum was 
present. It has been the custom to appoint some 
member of the society to open the discussion on some 
subject designated by the president. In July, Dr. Mary 
E. Gaston, of Somerville, opened the discussion on 
" Hypnotics." In October, Dr. C. R. P. Fisher, of 
Bound Brook, opened the discussion on ** Antiseptics," 
and at our April meeting. Dr. Richard C. Norris, of 
Preston Retreat, Philadelphia, gave us a paper on . 
" Puerperal Infection." Dr. Norris discussed the import- 
ant questions of anti and post-partem douches, curettage 
and irrigation of the infected uterus, abdominal section 
and the use of antistrep to coccic serum. He also re- 
ported a case in which favorable results followed the use 
of the serum. 

The following new members have been added to our 
society: Dr. J. B. Beekman, of Pluckamin ; Dr. J. D. 
Ten Eyck, of Franklin Park and Dr. Irwin Fisher, of 



Harlingen. Dr. Isaac L. Compton, of Bound Brook, has 

been removed by death. There has been nothing 

unusual to note in the health of the community during 

the past year. 

A. L. STILLWELL. Reporter, 

SOMERVILLE, N. J.. June 9, 1897. 


To the Chairman of the Standing Committee, &c,: 

The district medical society for Sussex County held its 
annual meeting at Newton, in May, 1897. An interest- 
ing address was given by the president, Dr. S. Voorhees, 
on typhoid fever. In the discussion which followed, the 
Brandt method of treatment and the antiseptic method 
had about an equal number of supporters. Measles was 
reported epidemic in the northern and eastern part of 
the county, and mumps was also prevalent during the 
year. The various boards of health in the county have 
been more active during the past year, in their duties, 
than heretofore. A few cases of typhoid fever, also a 
number of scarlet fever and of diphtheria were reported 

in Newton. 

Respectfully submitted, 



To the Chairman of the Standing Committee, &c,: 

The sanitary condition of Union County, outside of 
the city of Elizabeth, has been much improved, princi- 
pally by the improvement of the sewer systems in several 
of the smaller towns. The trunk sewer proposed for 


Elizabeth has not yet been constructed. The city has 
acquired a well equipped contagion hospital, though 
necessity for its use has not yet occurred. 

Diphtheria has been very prevalent during the past fall 
and winter. The number of cases has been very large 
but the mortality very low. Most physicians give anti- 
toxine the larger share of credit. Some, however, claim 
that the type of the disease has been mild, and thus 
account for the low death-rate from this affection. 
Scarlet fever, though hardly epidemic, has attacked a 
large number of persons. The type has been rather 
mild. Whooping-cough has been, and is, very prevalent, 
obstinate and severe. Measles, not as common as for 
some time previously. Typhoid has been quite rare. 

The Union County Medical Society , has held four well 
attended and very interesting meetings during the year. 

Papers read and discussed were as follows : " Cathode 
Rays in Medicine and Surgery,'* by Dr. Scofield ; "Aden- 
oids of the Pharynx," by Dr. Ard ; ** Relation of Uric 
Acid Diathesis to Hay Fever," by Dr. Wilson ; " Clinical 
Report on the Treatment of Diphtheria by Antitoxine," 
by Dr. R. B. Whitehead. 

At the last meeting the following officers where elected : 
President, E. W. Hedges; Vice-President, J. S.Green; 
Secretary, J. B. Harrison; Treasurer, R. J. Montfort; 
Reporter, R. B. Whitehead. Six additions to the mem- 
bership list has been made, and I regret to be obliged to 
chronicle the loss, by death, of two from the same list, 
namely : Dr. W. K. Gray, of East Orange, and Dr. D. E. 
Decker, of Woodbridge. 

Respectfully yours, 

R. B. WHITEHEAD, Reporter, 
Elizabeth, N. J., May 25, 1897. 



To the Chairman of the Standing Committee^ &c,: 

The reports from some sections of Warren County, for 
the past year, are not as favorable and cheering as they 
were during the several previous years, although we have 
very little reason to complain. There have been a few 
epidemics, the most noticeable being that of diphtheria, 
in PhilHpsburg. The health officer of the town reports 
to me that he has tabulated and quarantined 137 cases of 
said disease since October 10, 1896, with seventeen deaths. 

Antitoxine was used in about eighty per cent, of the 
cases, and in nearly every instance with marked success. 
During the four previous months of the year, there were 
many cases of the said disease, but owing to the death of 
our efficient and venerable health officer, W. G. Tomer, 
last September, the records during his time in office can- 
not be found. However, the death-rate under the treat- 
ment of antitoxine was about the same. The board of 
health, of PhilHpsburg, has done noble work during the 
past year. In every instance where a case of contagious 
or infectious disease has been reported, the yellow flag 
has been di^ly placed in a prominent position, notwith- 
standing the protests of those directly interested, and the 
location properly quarantined. I learn that in certain 
towns and localities in this county, where contagious 
diseases have existed, the health boards are very lenient, 
and even careless and indifferent as to their prescribed 
duty. Cases of diphtheria and scarlet fever have existed 
in certain families ; the patients placed in a presumed 
isolated apartment ; children in same family continue 
going to school while residing at home, and members of 
said families go and come at pleasure, in the town or 
community. No flag or mark of danger is placed on the 


premises, and for all practical purposes, the local board 
of health is a myth. 

Our county society is in a very flourishing condition. 
The annual meeting was held at Belvidere, on the 
eighth of this month, with an attendance of seventeen 
members and one visitor, out of a membership of twenty- 
one, as per report to State Society for 1896. Much 
enthusiasm and good feeling existed, which we feel 
certain will continue. 1 have the pleasure of submitting 
the following interesting reports. 

Truly yours, 

J. H. GRIFFITH, Reporter, 

Phillipsburg, N. J., June 14, 1897. 



In the early part of May] there was an outbreak of diphtheria in 
the lower part of the town. Four cases in a family of eleven was the 
result. A girl ten years of age was the first to be attacked. As soon as a 
diagnosis was made, antitoxin was used, the case isolated and a strict 
quarantine maintained. This case died twelve days after the disap- 
pearance of the disease, from paralysis of the heart. Immediately 
after the diagnosis of diphtheria, two children, inmates of the house, 
were removed to the house of a relative two miles away in the country. 
There were three children left in the house ; two were too small to 
be away from their mother and the other one was sick with the 
measles. The others in the house were adults. 

Through strict isolation and the free use of disinfectants, the 
children kept in the house were not affected with the disease. The 
two sent away were attacked by a very malignant form of diphtheria, 
and one died about ten days after the diphtheritic symptoms had 
disappeared. Death in this case was also from paralysis of the heart. 
Another child in the country house was attacked and received 
antitoxin within ten hours after the appearance of diphtheria, and had 
a mild form of the disease. In this case the antitoxin seemed to abort 
the disease and it is now convalescent. 

342 mIdical society of new jersey. 



On the morning of May 28, 1897, Mrs. M., aged 38 years, the mother 
of five children, was taken with what she supposed to be a return of 
her menstrual flow, not having menstruated for the past nine months, 
the cessation of which she attributed, on the advice of some old woman, 
to be due to the change of life. Soon after the flow began, she had 
pains resembling labor pains, which continued through the day. 
Late at night, when I was called to see her, I found upon examination, 
a uterus about the size of a three months' pregnancy, os dilated and 
membranes bulging, pains gone. 

I ruptured membranes, and after due time delivered her of a foetus 
about 4i inches long, weighing about 5,000 grains, perfectly 
developed and of a doughy consistency, very tender, the arm coming 
off by the gentlest traction. The placenta was adherent and very 
tender, so much so as to be removed with difficulty ; after which I 
gave her a uterine douche. No unfavorable symptoms followed and 
the patient made a rapid recovery. The foetus was no doubt 
arrested in its growth about the third month of foetal life, and the 
woman carried it a full term without any symptoms of pregnancy 
except the cessation of the menses. 



Case I. — Male, A. R., age 27, laborer. Was called to see him 
Dec. 15, 1897; found him suffering with great pain all over the body, 
especially the knee joints ; temp, during the first week, on three 
alternate days, 106 ; coated tongue. After this he developed typhoid 
symptoms of a rather moderate type, with some improvement latter 
part of fourth week, a relapse in fifth, terminating in recovery latter 
part of seventh week. I report this case on account of the prodomic 
stage. His mother, age 48, nursing him, rather weak and anemic, 
had also an attack of a few weeks' duration, which I consider she 
contracted from him. 

Case 2, — Was called to see C. H., male, age 45, machinist, March 2, 
1897. Found him suffering with severe pains in the limbs ; coated 
tongue; temp. 104, pulse 115 ; on the right infraobital region he had 


developed an erysipelatous dermatitis, which, in a few days, spread 
over the face, including the ears. On the 6th, albumen appeared in 
the urine, after which he ran into convulsions and coma, death follow- 
ing on the 7th. 



Case I, — Was hastily called to see Mr. C, aged 35 years, from 
Brooklyn, N. Y. While coasting down hill, near Hackettstown, on 
his bicycle, he fell, head first, into a large pile of rocks, inflicting an 
ugly scalp wound, besides being generally shaken up. I found him 
suffering from shock, and upon examination of his injuries, I found 
a very extensive scalp wound, beginning at the margin of the hair on 
the forehead. The skin was cut almost straight across and then 
peeled back off the skull to the crown of the head. The man gave 
no evidences of fracture of the skull. The wound was sutured care- 
fully and dressed antiseptically and it healed by first intention in 
about a week, leaving no scar except a very faint red line along the 
margin of the hair, which was hardly perceptible except on close 

The man was delirious for about three weeks; temperature would 
sometimes run up to 103**. He had all symptoms of concussion of 
the brain, following the injury, and at the end of the third week he 
began to improve and went steadily on to complete recovery. 

Case 2, — Was called in April last, to see Mrs. McC, aged 66 years. 
Her first symptoms were those of a bad cold. Upon close question- 
ing I found patient had not had measles and had been exposed. 
There was then no sign of any rash, but the skin burned and itched a 
great deal, and as patient was very fleshy, she suffered intensely from 
the burning of the skin. She was cautioned about catching cold, but 
one night, just as the measels were breaking out, she arose from her 
bed saying she was so hot she must have air, and went and sat in the 
open window. The result was pneumonia of the severest type. She 
went on with this for about a week and became very low indeed ; we 
expected her death any hour ; pulse was very irregular ; temperature 
104 and the dyspnoea was intense. The treatment in this case had 
been carbonate of ammonia and Dovers* powder, and when the 
dyspnoea became so bad I determined to try a large blister. It was 


done with a result very satisfactory. In one hour after the blister 
began to draw, the dyspnoea began to lessen, and from that time on 
her symptoms began to improve and she recovered. This case is 
interesting from the fact of the woman's age, combined with a weight 
of two hundred and thirty-five pounds, and the cold accompanied by 
measles, which cases are always more serious. 



I mention a case of diabetes mellitus, in a lady of seventy, existing 
for eight years, with less constitutional depression than usual, in 
whom a gangrenous spot appeared, on her right toe, with a tender- 
ness through the foot and leg as far as the knee. The skin was 
extensively affected with eczema and purpura. The dead tissue was 
removed with forceps and scissors. The local treatment was, cleansing 
by wash of hydrogen dioxide, dusting with vitogen and starch and 
covering the surface of the ulcer with balsam peru. The constitu- 
tional treatment was the use of benzoate of soda and codeine. The 
healing was rapid after the removal of the dead tissue and her 
general condition greatly improved. 












Report of Corresponding Secretary 67 

Report of Treasurer 70 

Report of Delegate to the New Hampshire State Medi- 
cal Society 72 

Paper read by Dr. G. H. Balleray, in opening the Discus- 
sion ON •• In the. Treatment of Appendicitis is the 

Free Use of the Knife Necessary ? " 73 



The Value of Antitoxin as a Remedial Agent and as a 

Protection Against Diphtheria, by George Bayles, M.D.. 105 
The Present Status of the Serum Treatment of Diph- 
theria, by Alexander McAllister, M.D 127 

Headaches; Auto-Intoxication a Factor, by Luther M. 

Halsey, M.D 135 

A Criticism op Modified Milk and of Modern Dairy 

Methods, by Richard Cole Newton, M.D 165 

"Some Important Points for Consideration in the Treat- 
ment OF Acute Lobar Pneumonia, by Louis Faugeres 

Bishop, A.M., M.D 187 

Scarlet Fever Reproduced by Inoculation; Some Import- 
ant Points Deducted Therefrom, by Joseph William 

Stickler, M.S., M.D ; 201 




Progress IN State. Medicine and Hygiene, by Henry 

Mitchell, M. D .• 225. 

Aphorisms on Medico-Lbgal Testimony, by William H. Iszard. 

M.D ., i 231 

Progress in Bacteriology During the Past Year, by John 

S. Billings, Jr., M.D 236- 

Progress of Ophthalmology and Otology, by Talbot R, 

Chambers, M.D 245 

Report on Diseases of the Nose and Throat, by E. Fayette 

Smith, M.D 258- 

An Account of a Patient in the New Jersey State 

Hospital who Swallowed Numerous Indigestible 

Articles with Suicidal Intent, by B. D. Evans, M.D 263. 

Report on Surgery, by Charles Young, M.D 268. 


JULIUS M. Simpson, M.D 295. 

Thomas Garwood Rowand, M.D 295. 

Charles R. Wiley, M.D 297 

WiiLiAM Raby Little, M.D 299 

John Kirby, M.D 300 

A. Van Nest Baldwin, M.D 301 

Isaac L. Compton, M.D 302: 

William Kelly Gray, M.D 303 

Dayton E. Decker, M.D 303; 

ATLANTIC COUNTY, Report by William Edgar Damall, M.D. 305 

BURLINGTON COUNTY, Report by Joseph Stokes, M.D 397 

CAMDEN COUNTY, Report by Daniel Strock, M.D 30& 

Camden County Hospital, by Jo.seph E. Hurff, M.D 315. 

CUMBERLAND COUNTY, Report by J. C. Applegate, M.D 318. 

GLOUCESTER COUNTY, Report by Charles S. Heritage, M.D. 320 

HUDSON COUNTY, Report by J. A. Exton, M.D 323. 

Case of Asphyxia, by Calvin F. Kyte, M.D 324 

HUNTERDON COUNTY, Report by G. N. Best, M.D 326- 

MERCER COUNTY, Report by George N. J. Sommer, M.D 327 

MIDDLESEX COUNTY, Report by A. L. Smith, M.D 329 

MONMOUTH COUNTY, Report by Franklin C. Price, M.D 329. 

MORRIS COUNTY, Report by E. P. Cooper,.M.D 331 

Cancer of the Rectum ; A Unique Case, with Obscure 

Symptoms, by L. Farrow, M.D 333; 

SALEM COUNTY, Report by Warren L. Ewen, M.D 336- 

SOMERSET COUNTY, Report by A. L. Stillwell, M.D 337 

SUSSEX COUNTY, Report by Sidney B. Straley, M.D 338 




UNION COUNTY, Report by R. B. Whitehead, M.D 338 

WARREN COUNTY, Report by J. H. Griffith, M.D 340 

Case, by William Stites, M.D ^ 341 

Case, by C. B. Smith, M.D... 342 

Case, by A. P. Jacoby, M.D 342 

Case, by L. C. Osmun, M.D 343 

Case, by J. C. Johnson, M.D 344 


The Medical Society of New Jersey does not hold 
itself responsible for the sentiments expressed by the 
authors of papers ; nor for the reports of clinical cases 
furnished by the reporters of the District Societies. — 
Transactions i8y6y page j8.